Investigation of the Actual Causes of Hip Joint Implant Loosening Classified as Aseptic--Analysis of Microbiological Culture Results and Levels of Inflammatory Markers.

Loosening of the hip joint prosthesis is considered as one of the most significant postoperative complications in recent years. The laboratory diagnostic procedure used to differentiate periprosthetic infection from aseptic loosening is very difficult because of the biofilm which microorganisms form on the implant surface. The purpose of this research was to evaluate the level of concordance between clinical classification of implant loosening among 50 patients subjected to reimplantation procedure and laboratory investigation of PJI including microbiological culture results and the levels of inflammatory markers assessed in the patients' synovial fluid samples, serum, and full blood. The synovial fluid was collected for leukocyte count, differential cell count, and culture on standard media. The levels of systemic inflammation markers such as the ESR and CRP concentration were determined in serum and full blood. Tissue samples were collected for microbiological studies. Components from endoprostheses were exposed to ultrasound in a process called sonication. Among the parameters measured in serum and full blood the levels of ESR and CRP were higher in the septic group of patients. Cytologic analysis of synovial fluid was in correlation with microbiologic identification. The most frequent isolated bacteria was Staphylococcus epidermidis. Culture results from materials such as synovial fluid, sonicate and tissues are crucial to establish the infectious aetiology of the loosening. Microscopic analysis of synovial fluid represents a simple, rapid and accurate method for differentiating PJI from aseptic failure. Sonication increases detection of the infectious process, and culture results are in correlation with the cytologic analysis of synovial fluid.

Sonication as a diagnostic approach used to investigate the infectious etiology of prosthetic hip joint loosening.

The purpose of the study was to evaluate the usefulness of sonication for the diagnosis of prosthetic joint infections (PJIs) by its comparison with periprosthetic tissues (PTs) and synovial fluid (SV-F) cultures. The study groups included 54 patients undergoing exchange of total hip prostheses for so called "aseptic" loosening occurring without clinical manifestations of an accompanying PJI and 22 patients who developed a sinus tract communicating with the prosthesis which was indicative of an ongoing infectious process. Significant positive culture results were obtained among 10 (18.5%) patients with "aseptic" implant failure and in 18 (81.8%) patients who developed a sinus tract. Sonicate-fluid (S-F) yielded bacterial growth in all culture-positive patients with "aseptic" loosening vs. 15 patients with presumed PJIs. There was a concordance in terms of bacterial species isolated from S-F and conventional cultures from individual patients. Coagulase-negative staphylococci were isolated most frequently. Sensitivity of sonication (75%) exceeded that estimated for PTs (69%) and SV-F (45%) cultures. We conclude that identification of causative agents of PJIs which is critical to further therapeutic decisions is aided by the combination of sonication and conventional culture.

Infectious prosthetic hip joint loosening: bacterial species involved in its aetiology and their antibiotic resistance profiles against antibiotics recommended for the therapy of implant-associated infections.

Reliable microbiological diagnosis along with surgery and prolonged antibiotic therapy are key elements in the management of prosthetic-joint infections (PJIs). The purpose of this study was to characterize antibiotic resistance profiles of bacteria involved in the aetiology of PJIs. A total of 33 bacterial isolates cultured from 31 patients undergoing exchange of total hip prostheses were analyzed. The diagnostic approach toward isolation of prosthesis- associated microorganisms included sonication of retrieved implants and conventional cultures of periprosthetic tissues and synovial fluid. The in vitro resistance profiles of bacterial isolates were determined in relation to antibiotics recommended for the therapy of PJIs using the disc diffusion method, E-tests(®) and broth microdilution system. Coagulase-negative staphylococci (CNS) were predominant microorganisms followed by Staphylococcus aureus, Enterobacter cloacae, Streptococcus mitis, and Propionibacterium acnes. Twenty out of 30 and 12 out of 30 staphylococcal isolates were methicillin- and multi-drug resistant, respectively. Only two isolates were rifampicinresistant. All staphylococci were susceptible to glycopeptides and linezolid. This paper stresses the pathogenic role of staphylococci in patients suffering from implant loosening and reports high methicillin- and multidrug-resistance rates in these bacteria. Hence, antimicrobial susceptibility tests of individual bacterial isolates must always be performed to guide selection of the optimal therapeutic option.

[Reasons for delay in treatment of breast cancer detected due to breast self-examination in women from the Lubelskie region]. / Przyczyny opóznien leczenia chorych na raka piersi wykrytego w trakcie samobadania u kobiet w województwie lubelskim.

OBJECTIVES: A delay in diagnosis and treatment of breast cancer patients is observed despite access to modern diagnostic methods. The aim of the study was to evaluate time between the first symptoms of breast cancer and treatment commencement, as well as to analyze reasons for the delay MATERIALS AND METHODS: The research was conducted on 260 breast cancer patients treated at the Oncology Center in Lublin between 2008 and 2011. 'Patient delay' was defined as the time gap of > 3 months between first symptoms of cancer and the doctor's appointment and 'system delay' as the time gap of > 1 month between the first medical consultation and commencement of treatment. RESULTS: Mean patient delay was 32.2 +/- 63.8 weeks. The main reasons were: disregard of symptoms (51%) and fear of being diagnosed with cancer (48%). Factors which significantly influenced the length of patient delay included: age > 65 years, non-regular gynecologic care, lack of prior cancer screening and lack of family history of breast cancer Mean system delay was 3.1 +/- 2.9 weeks. Tumors < 5 cm in diameter and clinical presentation other than a tumor significantly influenced the system delay CONCLUSIONS: A significant delay in diagnosis and treatment of breast cancer remains to be noted. Delay in seeking medical help was observed in 20% of the patients, whereas the referral was delayed due to system fault in 38% of the cases. Contrary to popular belief, patient delay (mean 32.2 +/- 63.8 weeks) is 10 times longer than system delay (3.1 +/- 2.9 weeks), suggesting an urgent need for further education of the general public and creating more accessible medical care.

Biomechanical parameters of the BP-enriched bone cement.

Bisphosphonates (BPs) are well-known substances with very efficient antiresorptive properties. Their beneficial actions are useful not only in achieving better bone mineral density but also in improving bone microarchitecture, strength and, consequently, its quality. Surgical cement, being a polymer composite, is required to be highly biocompatible and biotolerant. The goal of the presented study was to assess whether the enrichment of cement with pamidronate has changed its biomechanical properties. We compared the biomechanical parameters of clean bone cement and BP-enriched bone cement, which were both used formerly in our rat models. Biomechanical properties of BP-enriched bone cement are defined by two basic terms: stress and strain, which are caused by the influence of external force. In the investigatory process of the bone's biomechanical parameters, the compressive test and the three-point flexural tests were used. During the three-point flexural investigation, the sample was supported at both ends and loaded in the middle, resulting in a flexure. After a specific range of flexure, the sample was fractured. In obtained results, there were no significant differences in the values of the stress determined at the point of maximal load and the energy stored in the samples for proportional stress-strain limit (elastic region). There were also no significant differences in the density of the samples. The study shows that the enrichment of bisphosphonates causes yielding of the bone cement material. In the presented data, we conclude that use of pamidronate implanted in bone cement did not have a detrimental effect on its biomechanical properties. Therefore, the obtained results encouraged us to perform further in vivo experiments which assess the biomechanical properties of bones implanted with BP-enriched bone cement.

The incidence of EGFR-activating mutations in bone metastases of lung adenocarcinoma.

Poor prognosis of lung adenocarcinoma is associated with early occurrence of distant metastases. This type of non-small-cell lung carcinoma more frequently involves EGFR gene abnormalities, which determine the efficacy of EGFR tyrosine kinase inhibitor therapies (EGFR TKIs). It is probable that genetic abnormalities present in primary tumor will also be present in metastases. Unfortunately little is known about the incidence of these mutations in the metastases and about the effectiveness of molecularly targeted therapy in such patients. Formalin-fixed, paraffin-embedded tumor tissue was prepared from 431 samples of primary adenocarcinoma, 61 of adenocarcinoma central nervous system (CNS) metastases and 8 of adenocarcinoma bone metastases. The presence of exon 19 deletions was examined using the PCR technique and amplified PCR product fragment length analysis. The ASP-PCR technique was used to evaluate the L858R substitutions in exon 21, and the results were analyzed using ALF Express II sequencer. In the adenocarcinoma metastases to bone obtained from 8 patients, deletions in exon 19 of the EGFR gene were revealed in 3 smoking men and one non-smoking woman, while L858R substitution in exon 21 was found in one smoking woman and one man of unknown smoking status. The incidence of EGFR gene mutations in the bone metastases was 75%, in the primary adenocarcinoma--12.8%, and in the adenocarcinoma metastases to CNS--14.75%. Five patients with EGFR gene mutation revealed in bone metastases were treated with EGFR TKIs; the majority of them had a satisfactory response to therapy.

Characterization of Staphylococcus epidermidis and Staphyloccocus warneri small-colony variants associated with prosthetic-joint infections.

We determined the frequency of isolation of staphylococcal small-colony variants (SCVs) from 31 culture-positive patients undergoing revision of total hip prosthesis for aseptic loosening or presumed prosthetic-joint infection (PJI). We analysed auxotrophy of cultured SCVs, their antimicrobial susceptibility profiles and their biofilm-forming capacity. Eight SCV strains were cultivated from six (19 %) patients. All SCVs were coagulase-negative staphylococci (CNS) with Staphylococcus epidermidis as the predominant species; there was also one Staphylococcus warneri SCV. The SCVs were auxotrophic for haemin, with one strain additionally auxotrophic for menadione. We noted the presence of two phenotypically (differences concerning antimicrobial susceptibility) and genetically distinct SCV strains in one patient, as well as the growth of two genetically related SCVs that differed in terms of their morphology and the type of auxotrophy in another. Seven out of eight SCVs were resistant to meticillin and gentamicin. In addition, antibiotic sensitivity testing revealed three multidrug-resistant SCV-normal-morphology isolate pairs. One S. epidermidis SCV harboured icaADBC genes and was found to be a proficient biofilm producer. This paper highlights the involvement of CNS SCVs in the aetiology of PJIs, including what is believed to be the first report of a S. warneri SCV. These subpopulations must be actively sought in the routine diagnosis of implant-associated infections. Moreover, in view of the phenotypic and genetic diversity of some SCV pairs, particular attention should be paid to the investigation of all types of observed colony morphologies, and isolates should be subjected to antimicrobial susceptibility testing.

Prevalence of genetic risk factors related with thrombophilia and hypofibrinolysis in patients with osteonecrosis of the femoral head in Poland.

BACKGROUND: The etiology of osteonecrosis of femoral head (ONFH) has not been fully elucidated. Increased intravascular coagulation and/or hypofibrinolysis have been proposed as pathogenic mechanisms. Previous reports demonstrated significant association between incidence of ONFH and polymorphisms of genes related with thrombophilia especially in Caucasian subjects. The aim of our study was to evaluate the relationship between genetic mutations leading to coagulation disorders and ONFH in Polish patients. METHODS: We have investigated the frequencies of four markers among 68 unrelated individuals with clinically and radiographically documented ONFH and among 100 healthy unrelated blood donors in Eastern part of Poland. The three genes were involved in thrombophilia: factor V Leiden (G1691A), prothrombin (G20210A), Methylenetetrahydrofolate Reductase (MTHFR C677T) and one in hypofibrinolysis: Tissue Plasminogen Activator (PLAT TPA25 I/D). The samples were genotyped with polymerase chain reaction followed by restriction enzyme analysis for the restriction fragment length polymorphisms. The allele and genotype frequencies were analyzed in the relation to ONFH etiology (idiopathic and secondary), gender, age (patients younger or older than 50 years) and the number of affected joints (unilateral or bilateral ONFH). RESULTS: No significant difference in allele frequencies between patients and control groups were observed in genes involved in thrombophilia. We have found a statistically significant increased frequency of D allele of PLAT TPA 25 I/D polymorphism between the entire group of patients with ONFH and controls (p=0,026, OR=1,54, CI 0,99-2,4). D allele frequency was also significantly increased in patients with primary ONFH (p=0,009, OR=1,81 CI 1,1-3,01), in males (p= 0,013; OR 1,74; 95% CIs 1,08-2,78), patients older than 50 years (p= 0,018, OR= 2,04; 95% CIs 1,09-3,82) and in cases with bilateral ONFH (p= 0,01; OR= 1,92; 95% CIs 1,13-3,27) (Table 9). The differences in DD homozygous genotype frequency were statistically significant for patients with idiopathic ONFH compared with control group (p=0,023, OR=2,75, CI 0,99-7,9) and in cases of bilateral ONFH (p=0,034; OR 3,12; 95% CIs 1,06-9,18) (Table 10). The frequencies of ID heterozygous genotype were statistically significantly higher in entire group of patients with ONFH (p=0,004 OR 2,71; 95% CIs 1,32-5,57), idiopathic ONFH (p= 0,01; OR 2,91; 95% CIs 1,24-6,87), males (p=0,0007; OR 3,75; 95% CIs 1,67-8,42), patients older than 50 years (p=0,001; OR 6,89; 95% CIs 1,87-25,84) and in cases with bilateral ONFH (p=0,009; OR 3,19; 95% CIs 1,26-8,03). CONCLUSION: The results suggest that inherited hypofibrinolysis is a risk factor of idiopathic ONFH in Polish population.

Endothelial nitric oxide synthase gene intron 4 polymorphism in non-traumatic osteonecrosis of the femoral head.

PURPOSE: Nitric oxide (NO) synthesised by endothelial NO synthase (eNOS) is a potent regulator of internal haemodynamics. A polymorphism in intron 4 of the eNOS is associated with different vascular disorders. We investigated the potential involvement of this polymorphism in idiopathic and secondary osteonecrosis of the femoral head (ONFH) in Polish patients. METHODS: We performed a study involving 68 patients with ONFH (45 idiopathic and 23 secondary) and 100 healthy controls. All subjects were genotyped for the eNOS4 polymorphism by the polymerase chain reaction followed by agarose gel electrophoresis. RESULTS: The analysis revealed that the frequencies of eNOS4 genotypes were significantly different in ONFH patients (both idiopathic and secondary) than in controls. The frequencies of the 4a allele were significantly higher in the total group of patients versus controls [22.79 vs 9%, p = 0.00039, odds ratio (OR) 2.98]. In subgroup analysis the 4a allele increased significantly in both idiopathic (20 vs 9%, p = 0.0074, OR = 2.52) and secondary (28.26 vs 9%, p = 0.00047, OR = 3.98) ONFH patients compared to control subjects. The frequency of the 4a/b genotype in the total group of patients (36.76 vs 16%, p = 0.0011, OR = 3.24) as well as patients with idiopathic (35.56 vs 16%, p = 0.0069, OR = 2.96) and secondary (39.13 vs 16 %, p = 0.0073, OR = 3.89) ONFH was higher than in the control group. CONCLUSIONS: There was a significantly higher frequency of eNOS 4a allele carriers among the total group of patients as well as in idiopathic and secondary ONFH. This suggests that the eNOS gene polymorphism may be associated with increased risk of ONFH.

Effect of implanted bisphosphonate-enriched cement on the trabecular microarchitecture of bone in a rat model using micro-computed tomography.

PURPOSE: Bisphosphonates (BPs) are antiresorptive drugs typically used to inhibit bone resorption. The latest reports show that BPs play an important role in not only achieving better bone mineral density but also in improving bone microarchitecture. The mechanism of action of the BPs is complex and multifactorial. We tried to determine whether there are any changes in the microarchitectural bone structure during local use of BP (Pamifos 60). The aim of this study was to see if BP-enriched cement used in rat models had positive effects on bone formation. METHODS: Research was performed on 40 adult male Wistar rats that were divided into four groups: two control groups and two experimental groups. Rats in the experimental groups were implanted with BP-enriched cement into the bone, while the control group rats were implanted with clean bone cement (without BP). Micro-computed tomography was applied for the investigation of trabecular microarchitecture of the proximal physis of the tibial bone in all animals three and six weeks after surgery. In all microCT images variables such as bone volume density (BV/TV), trabecular thickness (TbTh), trabecular separation (TbSp) and trabecular number (TbN) were used to describe trabecular bone morphometry. RESULTS: The major finding of this study is that using BP-enriched cement results in distinct changes in bone microarchitecture. We showed that local use of pamidronate (Pamifos 60) in orthopaedic cement had a positive effect on bone formation. It significantly changed three variables. We noticed increasing bone volume fraction and trabecular thickness together with decreasing trabecular separation. CONCLUSION: In this paper we demonstrate the efficacy of using BP-enriched cement in vitro in the tibiae of rats. Our most significant finding based on micro-CT picture analysis allows us to start further work on more suitable applications of BP-enriched cement in humans. We believe that future successful experiments will facilitate potential use of BP-enriched cement in clinical applications.

Implanted bisphosphonates in bone cement affect bone markers in rat serum.

PURPOSE: Bisphosphonates (BPs) are antiresorptive drugs that provide important effects on bone turnover. The key to the high efficiency of BPs is their affinity for bone tissue, and their chemical structure provides their molecular mechanism of action. BPs are widely used to treat a variety of diseases that cause excess bone resorption, such as bone metastasis, hypercalcaemia due to malignancy and Paget's disease. The goal of this study was to assess whether the bisphosphonate (Pamifos®) present in bone cement has any effect on bone turnover. In this paper, we present changes in cytokine levels in the serum of rats treated surgically. METHODS: Research was performed on 40 adult male Wistar rats. The rats were divided into four groups: two control groups (A, B) and two experimental groups (C, D). Bone in rats in the experimental groups was implanted with BP-enriched cement, whereas bone in control-groups rats was implanted with clean cement (without BPs). RESULTS: We found a higher concentration of tumour necrosis factor alpha (TNF-α) three weeks after surgery in rats implanted with BP-enriched cement compared with rats implanted with clean cement. After six weeks of treatment, TNF-α levels decreased significantly in rats treated with BP-enriched cement, whereas the control group experienced an increase in TNF-α. The concentration of osteoprotegerin ligand (OPG) was higher in rats with BP implants. We found high levels of receptor activator of nuclear factor kappa-B ligand (RANKL) in rats after implantation of cement without BP in both groups. CONCLUSIONS: We conclude that use of bisphosphonate (Pamifos®), which is present in bone cement, has an effect on bone turnover in that BPs stimulate an increase in OPG and a decrease in RANKL in the bone microenvironment and thus may be an important component of mechanisms that reduce bone resorption. Therefore, the use of BP-enriched cement implants appears to be justified.

Evaluation of prognostic parameters of E-cadherin status in breast cancer treatment.

INTRODUCTION AND OBJECTIVE: Breast cancer is one of the most frequent malignancies in women. Axillary lymph node involvement, tumour size, receptor status, and level of malignancy are the most significant prognostic factors in breast cancer, but insufficient to date. More factors are needed for establishing the prognosis and treatment in these patients. The aim of the presented study was evaluation of E-cadherin expression and its prognostic value among 89 specimens of breast cancer. MATERIALS AND METHODS: 89 formalin-fixed and paraffin-embedded breast cancer specimens were studied for expression of E-cadherin detected by immunohistochemistry. During 10-year observation overall/OS/and disease-free survival/DFS/of patients were assessed. RESULTS: Average of OS and DFS were shorter among patients without expression of E-cadherin in comparison to survival time of patients with expression of E-cadherin. The lack of E-cadherin expression was present more often among patients with distant metastasis. No essential changes were noticed in the level of E-cadherin depending on the size of the tumour, G, presence of metastasis into the lymph nodes, ER, PR and HER-2, hormonal condition and presence of cancerous tissues in lymphatic vessels and the infiltration of lymph nodes capsules. CONCLUSIONS: E-cadherin may play an important role in the prognosis of breast cancer patients.

The mechanical and histological estimation of calcaneal tendon callus in rats after PRP injection.

BACKGROUND: The study investigated the potential impact of platelet-rich plasma on tendon healing. MATERIAL/METHODS: The study was conducted in 88 young, sexually mature rats, Wistar strain. The animals were randomly divided into two groups. The animals from the examined group (n=44) with an operated calcaneal tendon were given subcutaneously allogeneic PRP. The animals from the control group (n=44) were given 0.9% NaCl solution within the area of calcaneal tendon damage. After 7, 14, 21, and 42 days, the tendons were tested mechanically using the universal testing machines (UTM, Lloyd LRX), and were subjected to histological evaluation. RESULTS: The study evaluated the maximum breaking force (Fmax), the force at the end of the proportional range (Fs) and stiffness of the tendons (H). After 7 days of the experiment, there were significant differences in H (P=0.021), between the examined and control groups. There were no significant differences in Fmax (P=0.53) and Fs (P=0.48) after 7 days. Mean values of Fmax, Fs and H after 14, 21, and 42 days in the study group were significantly higher compared to the control group (P<0.05). In the histological evaluation, the tendons of the examined groups were characterized by higher cellular and vascular density and a more orderly arrangement of collagen fibers compared to the control groups. CONCLUSIONS: Growth factors in allogeneic PRP increased the mechanical strength of regenerating calcaneal tendons after 14, 21, and 42 days from injury. PRP resulted in the increased histological maturity of the tendon callus in examined groups, at each stage of the experiment.

The evaluation of knee bone mineral density following open-wedge high tibial osteotomy.

Examinations of bone density changes in selected knee bone ends were evaluated prospectively in a randomized group of 28 patients, aged from 41 to 65 (mean: 55.3 years), who had varus deformations of their mechanic limb axes, mean 8 degrees. The examinations were conducted during the preoperative period, 10 days, 3, 6, and 12 weeks, as well as 6 and 12 months after the procedure. A statistically significant increase in bone density was observed in the medial tibial condyle area, while a statistically insignificant decrease of bone density was noted in the medial femoral condyles. Bone density increased in the lateral tibial condyle area, whereas there were no density changes in the area of the lateral femoral condyles. The research results demonstrate that the relief achieved in ailments after high tibial osteotomies does not directly correspond to the bone density of the affected areas.

[Large diameter femoral heads in primary alumina/alumina and XSPE/alumina total hip arthroplasty. A follow-up study of 50 hips after average 40 months and review of literature]. / Pierwotna calkowita bezcementowa endoprotezoplastyka stawów biodrowych--ceramika/ceramika i ceramika/polietylen XSPE z uzyciem glów o duzej srednicy. Ocena 50 bioder po okresie srednio 40 miesiecy i przeglad pismiennictwa.

INTRODUCTION: The aim of the study was a preliminary report of the use of large diameter alumina femoral heads in total hip arthroplasty. MATERIAL AND METHODS: In the years 2005-2008 50 THRs were implanted in 48 patients with the use of 36 mm alumina femoral heads. 5 women and 43 men in the age from 35 to 75 years (average 61 years) were operated on. Primary osteoarthritis was the cause of 41 arthroplasties, and AVN of femoral head of 9 surgeries. 18 alumina/alumina and 32 polyethylene/alumina THRs were implanted. The prospective study consisted of clinical examination with Harris Hip Score and X-ray evaluation. AP and lateral view X-rays were evaluated. The incidence of radiolucent lines around acetabular cups were noted with DeLee and Charnley zones and around stems with Gruen's zones. RESULTS: The follow up is from 24 to 58 months (average 40 months). There was an increase in Harris Hip Score from average 37 points (from 25 to 49 points) before operation to average 94 points (from 90 to 100 points) after the surgery. The incidence of postoperative dislocation have not been noted. Long-term postoperative X-ray examination have showed proper geometry of endoprostheses without radiolucent lines. Neither visible wear of bearing surfaces nor breakage of alumina components have been noted. CONCLUSIONS: 1) The use of 36 mm femoral heads in total hip arthroplasty decrease the risk of postoperative dislocation. 2) Innovative biomaterials: alumina ceramics and cross-linked polyethylene give chance for decrease the incidence of osteolysis.

[Results of operative treatment thoraco-lumbar fractures by posterior lumbar interbody fusion, Daniaux reconstruction or combination of both methods]. / Wyniki operacyjnego leczenia zlaman kregoslupa piersiowego i ledzwiowego tylna spondylodeza miedzytrzonowa, rekonstrukcja trzonu wedlug Daniaux oraz obiema metodami równoczesnie.

The aim of the study was to compare clinical and radiological results of treatment thoraco-lumbar spine fractures by short segment transpedicular stabilization accompanied by three techniques of reconstruction: posterior lumbar interbody fusion, vertebral body Daniaux reconstruction and combination of both methods. AO system was used to classify the fractures. Frankel's grade system was used for assessment of neurological deficit on admission and subsequently in the postoperative and follow-up period. The height of the fractured vertebral body and angle of segmental kyphotic deformation was measured on lateral X-ray pre- and post-operatively and at last follow-up. To the retrospective analysis we included 167 patients operated in the Orthopaedic and Traumatology Department, Medical University of Lublin in years 1998-2007. Posterior lumbar interbody fusion was performed in 69 patients (41%), isolated vertebral body Daniaux reconstruction in 82 patients (49%) and combination of both methods was performed in 16 patients (10%). The follow-up period has ranged from 3 to 13 years (mean 6.9 years). The most common type of the fracture was a B type (104 patients -62%), followed by type A (43 patients--26%), and type C (20--patients 12%). The neurological deficit was present in 80 patients. The postoperative neurological improvement was noticed in 37 patients (46%), whereas in 46 patients (54%) neurological status has not changed after the treatment. From 87 patients without neurological symptoms, we observed postoperatively contemporary neurological complications in 11 (12.6%) cases. The biggest correction of fractured vertebral height (mean 0.15) and correction of segmental kyphotic deformity (mean 6.3 degrees) we have noticed in the group of isolated vertebralbody Daniaux reconstruction with use of bone grafts. However in every group of patients we observed significant loss of correction during follow-up period. At the latest follow-up assessment there were no differences in vertebral body height of segmental kyphotic deformation between the analyzed groups of patients. None of analyzed methods of treatment: posterior lumbar interbody fusion, vertebral body Daniaux reconstruction or combination of these methods did not protect from recurrence of kyphotic deformity.

Evaluation of MP4OX for prevention of perioperative hypotension in patients undergoing primary hip arthroplasty with spinal anesthesia: a randomized, double-blind, multicenter study.

BACKGROUND: MP4OX (oxygenated polyethylene glycol-modified hemoglobin) is an oxygen therapeutic agent with potential applications in clinical settings where targeted delivery of oxygen to ischemic tissues is required. The primary goal of this study was to investigate MP4OX for preventing hypotensive episodes. An additional goal was to establish the safety profile of MP4OX in a large surgical population. METHODS: Patients (n = 367) from 18 active study sites in six countries, undergoing elective primary hip arthroplasty with spinal anesthesia, were randomized to receive MP4OX or hydroxyethyl starch 130/0.4. Patients received a 250-ml dose at induction of spinal anesthesia and a second 250-ml dose if the protocol-specified trigger (predefined decrease in systolic blood pressure) was reached. The primary end point was the proportion of patients who developed one or more hypotensive episodes. RESULTS: The proportion of patients with one or more hypotensive episodes was significantly lower (P < 0.0001) in the MP4OX group (66.1%) versus controls receiving hydroxyethyl starch 130/0.4 (90.2%). More MP4OX-treated patients experienced adverse events compared with controls (72.7% vs. 61.4%; P = 0.026). Transient elevations in laboratory values (e.g., alanine aminotransferase, aspartate aminotransferase, lipase, and troponin concentrations) occurred more frequently in the MP4OX group. There were no significant differences in the incidence of serious adverse events or in the composite morbidity and ischemia outcome end points, but nausea and hypertension were reported more often in MP4OX-treated patients. CONCLUSION: MP4OX significantly reduced the incidence of hypotensive episodes in patients undergoing hip arthroplasty, but the adverse event profile does not support use in routine low-risk surgical patients for the indication evaluated in this study.

Natural killer-like T CD3+/CD16+CD56+ cells in chronic lymphocytic leukemia: intracellular cytokine expression and relationship with clinical outcome.

The clinical significance of NK-like T CD3+/CD16+CD56+ cells in chronic lymphocytic leukemia (CLL) is still a subject of controversy. There are few previous descriptions that this cell population can be qualitatively or quantitatively deficient in CLL patients. In the present study we investigated the clinical value of CD3+/CD16+ CD56+ cells as predictors of disease progression. We assessed the frequencies of CD3+/CD16+CD56+ cells by the flow cytometry in a group of 300 CLL patients. The percentage of CD3+/CD16+CD56+ cell population expressed as the percentage of CD3+ lymphocyte compartment showed an inverse correlation with ZAP-70 and CD38. Additionally, the CD3+/CD16+CD56+ showed an inverse correlation with LPL/ADAM29 ratio. Likewise, the ability of these cells to cytokine expression correlated with ZAP-70 expression. A positive correlation between percentage CD3+/CD16+CD56+ cells and TFS was found. The decreased percentage of these cells was associated with higher death risk in CLL patients. Furthermore, the percentage of CD3+/CD16+CD56+ cells was significantly decreased in patients who showed progression of disease. This study suggests that assessment of CD3+/CD16+ CD56+ cells may be helpful in determining a worsening of clinical course. Monitoring of these cell numbers and function may provide useful information for determining disease activity. Especially, it could be intormative to look at these cells in patients with stage 0 CLL. For this patient group immunological control and dysfunction are probably important factors.

[Early experiences in the use of Mayo stem in hip arthroplasty]. / Wczesne doswiadczenia w zastosowaniu trzpieni Mayo w protezoplastyce bioder.

The aim of this study was early clinical and radiological examination of patients after THR with Mayo stem. In the years 2004-2007 at Orthopaedic and Traumatology Department, Medical University in Lublin 38 Mayo stems were implanted in 35 patients. There were: 5 women and 30 men in the age from 27 to 67 years (average 51 years). The main cause of surgery was primary coxarthritis in 17 hips, AVN in 17, and DDH in 4. Follow-up is from 12 to 48 months (average 24.2 months). Preoperative Harris Hip Score varied from 32 to 45 pts. (average 38 pts.) and increased to 75-100 pts. (average 96 pts.) at longest postoperative follow up. There was one postoperative dislocation of THR 3 weeks after the surgery. There was one Mayo stem migration nine months after the surgery (15 mm) with radiolucent lines in all Gruen's zones. Conclusions. 1) Operative technique of Mayo stem is easy even with minimalny invasive technique. 2) The use of metal on metal bearing surfaces with short metaphyseal stem in THR gives possibility for good durable clinical result

[First experiences with total hip resurfacing arthroplasty]. / Pierwsze doswiadczenia w calkowitej protezoplastyce powierzchniowej stawów biodrowych.

MATERIAL: From may 2005 25 surface arthroplasties were made in 10 women and 15 men in the age from 23 to 64 years (average 43 years). The main reason for arthroplasty was idiopathic arthritis in 20 patients. 24 ReCap (Biomet) endoprosthesis were implanted. The dysplastic BHR (Smith & Nephew) acetabular component was implanted in one patient because of the deficit of dysplastic acetabulum. RESULTS: The follow up is from 10 to 20 months (average 11 months). Clinical results in Harris Hip Score is from 90 to 100 points (average 95.8 pts). The average acetabular cup's angle of inclination is 51.2 degrees (from 40 to 77 degrees), and average femoral heads angle is 140.3 degrees (from 131 to 148 degrees). There were not any significant intraoperative and early postoperative complications. CONCLUSIONS: Early clinical results and data from bibliography confirm the value of surface arthroplasty in the treatment of young and active patients. The procedure is technically demanding.