Quantitative Description of Isomorphism in the Series of Simple Compounds.

The introduction of the notion of energy change resulting from the ion exchange in apatites leads to the question: how can some simple isomorphic series be described using the mentioned idea? We concentrated on the simple isomorphic series of compounds: apatite, bioapatite, calcite, aragonite, celestine, K-, Zn- and Cu-Tutton's salts. It was demonstrated in all the series, except Tutton's salts, that the change in energy and the change in the crystal cell volume are, in a simple way, dependent on the change in the ionic radii of the introduced ions. The linear relationships between the variations in energy and in the universal crystallographic dimension d were derived from the earlier equations and proven based on available data. In many cases, except the Tutton's salts, linear dependence was discovered between the change in energy and the sinus of universal angle Θ, corresponding to the change in momentum transfer. In the same cases, linear dependencies were observed between the energy changes and the changes in the volumes of crystallographic cells, and mutually between changes in the crystallographic cell volume V, crystallographic dimension d, and diffraction angle Θ.

Studies on Chemical Composition, Structure and Potential Applications of Keratoisis Corals.

The chemical composition and structure of bamboo octocoral Keratoisis spp. skeletons were investigated by using: Scanning Electron Microscopy SEM, Raman Microscopy, X-ray Diffraction XRD, Laser Ablation-Inductively Coupled Plasma LA-ICP, and amino acid analyzers. Elements discovered in the nodes (mainly organic parts of the skeleton) of bamboo corals showed a very interesting arrangement in the growth ring areas, most probably enabling the application of bamboo corals as palaeochronometers and palaeothermometers. LA-ICP results showed that these gorgonian corals had an unusually large content of bromine, larger than any other organism yet studied. The local concentration of bromine in the organic part of the growth rings of one of the studied corals grew up to 29,000 ppm of bromine. That is over 440 times more than is contained in marine water and 35 times more than Murex contains, the species which was used to make Tyrian purple in ancient times. The organic matter of corals is called gorgonin, the specific substance that both from the XRD and Raman studies seem to be very similar to the reptile and bird keratins and less similar to the mammalian keratins. The missing cross-linking by S-S bridges, absence of aromatic rings, and significant participation of ß-turn organization of peptides differs gorgonin from keratins. Perhaps, the gorgonin belongs to the affined but still different substances concerning reptile and bird keratin and in relation to the more advanced version-the mammalian one. Chemical components of bamboo corals seem to have great medical potential, with the internodes as material substituting the hard tissues and the nodes as the components of medicines.

Contribution to Knowledge on Bioapatites: Does Mg Level Reflect the Organic Matter and Water Contents of Enamel?

The matter constituting the enamels of four types of organisms was studied. The variability of the ions was presented in molar units. It was proven that the changes in water contents of the enamel are significantly positively related to changes in Mg; inversely, there is also a strong connection with changes in Ca and P, the main components of bioapatite. The variability in the organic matter has the same strong and positive characteristics and is also coupled with changes in Mg contents. Amelogenins in organic matter, which synthesize enamel rods, likely have a role in adjusting the amount of Mg, thus establishing the amount of organic matter and water in the whole enamel; this adjustment occurs through an unknown mechanism. Ca, P, Mg, and Cl ions, as well as organic matter and water, participate in the main circulation cycle of bioapatites. The selection of variations in the composition of bioapatite occurs only along particular trajectories, where the energy of transformation linearly depends on the following factors: changes in the crystallographic d parameter; the increase in the volume, V, of the crystallographic cell; the momentum transfer, which is indirectly expressed by ΔsinΘ value. To our knowledge, these findings are novel in the literature. The obtained results indicate the different chemical and crystallographic affinities of the enamels of selected animals to the human ones. This is essential when animal bioapatites are transformed into dentistic or medical substitutes for the hard tissues. Moreover, the role of Mg is shown to control the amount of water in the apatite and in detecting organic matter in the enamels.

Microscopic Droplet Size Analysis (MDSA) of "Five Thieves' Oil" (Olejek Pieciu Zlodziei) Essential Oil after the Nebulization Process.

Nowadays, due to a higher resistance to drugs, antibiotics, and antiviral medicaments, new ways of fighting pathogens are intensively studied. The alternatives for synthesized compositions are natural products, most of which have been known in natural medicine for a long time. One of the best-known and intensively investigated groups are essential oils (EOs) and their compositions. However, it is worth noting that the method of application can play a second crucial part in the effectiveness of the antimicrobial activity. EOs possess various natural compounds which exhibit antimicrobial activity. One of the compositions which is based on the five main ingredients of eucalyptus, cinnamon, clove, rosemary, and lemon is named "five thieves' oil" (Polish name: olejek pieciu zlodziei) (5TO) and is used in natural medicine. In this study, we focused on the droplet size distribution of 5TO during the nebulization process, evaluated by the microscopic droplet size analysis (MDSA) method. Furthermore, viscosity studies, as well as UV-Vis of the 5TO suspensions in medical solvents such as physiological salt and hyaluronic acid, were presented, along with measurements of refractive index, turbidity, pH, contact angle, and surface tension. Additional studies on the biological activity of 5TO solutions were made on the P. aeruginosa strain NFT3. This study opens a way for the possible use of 5TO solutions or emulsion systems for active antimicrobial applications, i.e., for surface spraying.

Hierarchy of Bioapatites.

Apatites are one of the most intensively studied materials for possible biomedical applications. New perspectives of possible application of apatites correspond with the development of nanomaterials and nanocompounds. Here, an effort to systematize different kinds of human bioapatites forming bones, dentin, and enamel was undertaken. The precursors of bioapatites and hydroxyapatite were also considered. The rigorous consideration of compositions and stoichiometry of bioapatites allowed us to establish an order in their mutual sequence. The chemical reactions describing potential transformations of biomaterials from octacalcium phosphate into hydroxyapatite via all intermediate stages were postulated. Regardless of whether the reactions occur in reality, all apatite biomaterials behave as if they participate in them. To conserve the charge, additional free charges were introduced, with an assumed meaning to be joined with the defects. The distribution of defects was coupled with the values of crystallographic parameters "a" and "c". The energetic balances of bioapatite transformations were calculated. The apatite biomaterials are surprisingly regular structures with non-integer stoichiometric coefficients. The results presented here will be helpful for the further design and development of nanomaterials.

Measurements of Energetic States Resulting from Ion Exchanges in the Isomorphic Crystals of Apatites and Bioapatites.

Developments in the field of nanostructures open new ways for designing and manufacturing innovative materials. Here, we focused on new original ways of calculating energy changes during the substitution of foreign ions into the structure of apatites and bioapatites. Using these tools, the energetic costs of ion exchanges were calculated for the exemplary cases known from the literature. It was established that the most costly were ion exchanges of some cations inside apatites and of anions, and the least costly exchanges in tetrad channel positions. Real energy expenses for bioapatites are much smaller in comparison to mineral apatites due to the limited involvement of magnesium and carbonates in the structure of hard tissues. They are of the order of several electron volts per ion. The rigorous dependences of the energy changes and crystallographic cell volumes on the ionic radii of introduced cations were proved. The differentiation of the positioning of foreign ions in locations of Ca(I) and Ca(II) could be calculated in the case of a Ca-Pb reaction in hydroxyapatite. The energetic effects of tooth aging were indicated. The ability of energy change calculation during the ion exchange for isomorphic substances widens the advantages resulting from X-ray diffraction measurements.

Histological changes in the epiphyseal plate of growing young adult male rats after long-term hydrocortisone and salmon calcitonin administration.

INTRODUCTION: Glucocorticosteroids decrease the longitudinal growth of bones. It has been reported that skeletally immature rats on calcitonin treatment grow longer and slimmer. The aim of this study was to assess whether concomitant treatment with calcitonin would influence longitudinal growth and histology of epiphyseal plate in hydrocortisone-treated rats. MATERIAL AND METHODS: Fifty six growing male Wistar rats were randomly divided into two control and four experimental groups. Rats in the first two experimental groups were treated i.p. b.i.d. with hydrocortisone, while to the other experimental animals salmon calcitonin s.c. was administered concomitantly. The controls received appropriate vehicula. The rats were kept under standardised conditions. The first phase of the experiment was completed after 28 days and right femora and tibiae were harvested from groups and preserved in 4% buffered formalin. Lengths of the fresh femora were measured with an electronic caliper. After preservation, tibial bones were decalcified in 5% EDTA at room temperature. Paraffin-embedded coronal slices 10 µm thick from proximal tibia were taken and stained with hematoxylin/ eosin and alcian blue for histological assessment of the epiphyseal plate. A similar procedure was repeated after 56 days in the second phase of the experiment. RESULTS: The femora of hydrocortisone-treated rats were significantly shorter than those of controls, but after concomitant administration of salmon calcitonin the difference was insignificant. The histological assessment showed that depressed function of growth plate in hydrocortisone-treated animals after both phases of the experiment was partially reversed by salmon calcitonin treatment. CONCLUSIONS: Prolonged concomitant treatment with high-doses of salmon calcitonin partially reverses glucocorticoid-induced depression of rat growth plate.

Psoriatic arthritis - new perspectives.

Psoriatic arthritis (PsA) is a seronegative arthropathy with many clinical manifestations, and it may affect nearly a half of patients with psoriasis. PsA should be diagnosed as early as possible to slow down joint damage and progression of disability. To improve the diagnosis of PsA, physicians should look for peripheral inflammatory pain, axial inflammatory pain, dactylitis, and buttock and sciatic pain. In most patients with PsA, pharmacologic treatment with non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, and biologic agents is effective. However, when pharmacological treatment fails, patients with PsA may benefit from orthopedic surgery, which can improve both joint function and quality of life. Total hip arthroplasty, total knee arthroplasty, and arthroscopic synovectomy of the knee are the most common surgical procedures offered to patients with PsA. The management of PsA requires the care of a multidisciplinary team, which should include dermatologists, rheumatologists, physiotherapists, and orthopedic surgeons.

Less invasive posterior surgical approach for hip joint replacement--complications and limitations.

BACKGROUND: We attempted to analyse the difficulties and risk of complications associated with total hip replacement using a limited posterior approach and standard instrumentation. MATERIAL AND METHODS: A series of 85 consecutive cases (47 females and 38 males; age range 22-87 years; mean age: 65.6 +/- 10.4) of total hip replacement using a modified Gibson approach were analyzed prospectively. Bilateral surgery was performed in 7 patients. There were 44 non-cemented arthroplasties. Body mass index varied from 22 to 36 (body weight 78-104 kg) and the length of the operative wound varied from 6.5 to 14 cm (mean 9.8 +/- 1.3 cm). The wound was 14 centimeters long in six subjects with a BMI of 35-36. The procedure was performed in a lateral decubitus position using an appropriately limited posterior approach. After careful coagulation of blood vessels surrounding the base of the femoral head posteriorly, the obturator and gemelli tendons and the posterior part of the joint capsule were cut through as close to the femoral attachment (T) as possible. This made it possible to dislocate the joint posteriorly. Further stages of the procedure were performed in a typical manner, with special attention paid to the preservation of the tendon of the piriformis muscle. Continuity of the muscle was re-examined following the reposition of the artificial joint. RESULTS: Two injuries to the piriform tendon were observed. Persistent bleeding from vessels surrounding the femoral neck base occurred in 5 patients while in four others there was transient paresis of the peroneal muscles and dorsal extensors of the ipsilateral foot, probably caused by extension of the sciatic nerve. There was one oblique fracture of the proximal femoral shaft. We did not observe significant errors in postoperative joint geometry. Mean intraoperative blood loss was 400 ml. We did not note postoperative dislocations or infections. CONCLUSIONS: On the basis of our observations of a series of 85 patients, minimizing the extent of the posterior surgical approach for hip joint replacement seems an attractive alternative to the classical extensive technique. Our material reveals a relatively high incidence of transient paresis of the peroneal part of the sciatic nerve. The introduction of appropriate instrumentation and the accumulation of experience will certainly decrease the risk of extension of the sciatic nerve in the operative wound.

Rationale for bisphosphonate use in patients with endoprosthesis.

Total joint replacement is accompanied by dramatic changes in the biomechanics of the adjacent bone. Under these conditions the phenomenon of stress-shielding is responsible for localized but significant bone atrophy. Another important and inevitable result of total joint arthroplasty is the production of wear debris particles, which recruit macrophages. These cells are present in abundance in osteolytic lacunae filled with pseudo-membranes, which are the cause of aseptic loosening of the implants. Bisphosphonates are an osteotrophic class of drugs that have been demonstrated to inhibit osteoclast-induced osteolysis. They are widely applied in bone pathologies in which osteoclastosis plays an important role, e. g. osteoporosis, Sudeck's bone dystrophy, Paget's bone disease, and many others. The routine administration of bisphosphonates in patients recovering from joint replacements seems to be fully justified. There is considerable evidence from both animal and human studies supporting the view that the suppression of osteoclastic activity is beneficial for the bone adjacent to metal implants. We have observed decreased joint pain in the early stages of aseptic loosening and stabilization of the x-ray picture of the bone adjacent to joint replacements after prolonged bisphosphonate treatment.

Postoperative limb lengthening following Total Hip Arthroplasty (THA) through a posterior approach--a challenge for the orthopaedist or physiotherapist?

BACKGROUND: As coxarthrosis progresses, pain and mobility limitation exacerbate, usually presenting as a progressive flexion-abduction contracture. This, combined with the degradation of articular ends of bones, is responsible for anatomical and functional shortening of the limb. The sensation of postoperative leg length difference is a significant problem both for the patient and the operator. A sense of the operated limb being longer may be due to excessive length of the femoral segment following total hip arthroplasty. It may also result from a postoperative abduction or flexion-abduction contracture. The aim of the study was to review the clinical course of total hip replacement surgeries. The focus was on complaints of leg length discrepancy persisting for more than two weeks after ambulation. MATERIAL AND METHODS: We investigated a series of 210 unilateral THA procedures. Swanson's technique through a posterolateral approach was used in all cases. Twelve patients, including 8 women and 4 men (out of the total of 210 patients - 169 women and 41 men), reported a sensation of operated limb lengthening for more than two weeks after ambulation. We reviewed the process of rehabilitation in this group of patients. RESULTS: The rehabilitation procedure presented in this paper eliminated the sensation of limb length discrepancy in all patients who had reported this problem. CONCLUSIONS: 1. Complaints of leg lengthening following total hip arthroplasty were reported by approx. 5% of the THA patients. 2. Consistent physiotherapy involving muscle energy techniques (MET) helped to eliminate the sensation of limb length inequality.

[Modified Swanson's hip replacement--intraoperative complications and learning curve of the procedure]. / Modyfikowany dostep Swansona w protezoplastyce stawu biodrowego--powiklania sródoperacyjne jako ilustracja krzywej uczenia nowej techniki operacyjnej.

Our study aimed at analysis and presentation of intraoperative complications during total hip replacements with the use of limited posterior approach according to T.V. Swanson. Consecutive 210 hip arthroplasies (79 males, 131 females, aged 20-87 years, mean age 61 +/- 12,) were analyzed according to intraoperative complications. Left hip was operated in 117 cases, right in 93, bilateral procedure was performed in 27 cases (9 men, 18 women). Idiopathic disease occurred in 196 hips, 8 were result of rheumatoid arthritis, in 5 was of dysplastic origin and one occurred due to idiopathic necrosis of femoral head. In 120 cases concomitant arthrosis of the lumbosacral spine and the other joints of the lower limbs was recorded. Preoperative Harris Hip Score (HSS) was 30 +/- 5 points and Body Mass Index (BMI) ranged from 23 to 36. Our clinical material was divided into three equeal series of consecutive hip replacements (n = 70). Each of the series represented different intraoperative complications. In the first series five intraoperative notorious bleedings, four transient sciatic nerve palsies, two injuries to piriforimis muscle and one spiral fracture of the proximal femur were noted. In the second series no important adverse intraoperative findings occurred. In the third series two perforations of the acetabulum and one fracture of the femur were observed. Differences of frequencies of vascular and neural complications between these three series appeared statistically significant. The authors suggested that these observations represent the "learning curve" of the new surgical procedure--the first phase reflects difficulties and technical errors, the second without complications--maturity of the procedure and the third one carelessness due to having false sense of "perfection" by the operators.

[Problem and tolerance of leg lengthening after total hip replacement]. / Problem i granica tolerancji wydluzenia konczyn po protezoplastykach stawów biodrowych.

Inevitable sequaelae of predominant number of hip arthritis is shortening of the upper end of the femur due to the destruction of the femoral cartilage and head which is usually accompanied by increasing flexion contracture. The main goal of hip replacement is to restore normal hip biomechanics and appropriate femoral neck lever. As the number of hip arthroplasties increases the patients dissatisfied with the early postoperative result related to the apparent lengthening of the operated limb are becoming more numerous. The authors retrospectively analyzed group of 10 patients complaining of postoperative lengthening limb derived from series of 210 hip replacements. In this group a rehabilitation programme comprising of repeated maneuvers of manipulation aiming at reduction of abduction contracture and obtaining adduction was performed. After a period of one week to six months in all the cases the perception of leg length discrepancy disappeared.

[Asymptomatic thrombo-embolic venous disease before total hip replacement--when the risk is important?]. / Bezobjawowa zylna choroba zakrzepowa przed operacja protezoplastyki stawu biodrowego--kiedy ryzyko jest istotne?

In spite of widely applied prophylaxis against thrombo-embolic venous disease its future complications still present important clinical issue. According to rough statistics this disease occurs in 71/100 000 persons per year and reveals in 1/3 as pulmonary embolism and in 2/3 as a pure thrombotic venous disease. Massive pulmonary embolism is at present a major cause of death in hospitalized subjects. In the USA mortality due to diagnosed pulmonary embolism is reported as approximately 25 000 cases per year. The aim of this paper is to draw attention to the asymptomatic cases of the thrombotic venous disease in the patients before hip arthroplasty. A retrospective clinical analysis of 210 total hip replacements (years 2005-2008) was performed. Standard perioperative routine antithrombotic prophylaxis with low-molecule heparins was introduced in each case. Special attention was paid to the occurrence of the risk factors or the presence of venous thrombosis in the lower extremities perioperatively. In the analyzed group preoperative ultrasound revealed in 5 (2.38%) cases asymptomatic venous thrombi reaching above the knee region and this was the cause of postponing of the procedure. In the early postoperative period pulmonary embolism was evidenced in 4 cases (1.9%). The authors suggested that preoperative ultrasound investigation of lower extremities venous system is important issue together with the assessment of d-dimers in the blood in all patients admitted to total hip arthroplasty. In any suspicion of the pulmonary embolism in these patients an angio-CT should be performed as an emergency.

[Orthopedic complications of antiphospholipid syndrome: presentation of two cases]. / Powiklania ortopedyczne zespolu antyfosfolipidowego: opis 2 przypadków chorobowych.

The authors describe 2 patients with systemic lupus erythematosus and antiphospholipid syndrome in whom aseptic necrosis of hips during low dose corticosteroids treatment were observed.

Multiple myxoid cysts of both hands in a cashier--a case report.

We describe an unusual case of mucous cysts in 3 fingers of both hands in a 52-year old woman, working as a cashier. The cysts were localized over the joints, between distal interphalangeal joint and the proximal nail fold. It is possible that the job of the patient (i. e. counting money with both hands, repeated straightening and bending of distal phalanxes in the palms) could have influenced the development of numerous lesions. Radiological examination revealed no symptoms of osteopathic changes, only the growth of soft tissue, without any abnormalities in the bone structure. Contact tests showed no allergy to nickel. The cryotherapy and removing mucus form the DMCs caused complete recovery of our patient.