Time efficiency of direct anterior hip arthroplasty compared to postero-lateral approach in elderly patients.

INTRODUCTION: Primary arthroplasty of the hip joint is currently one of the most commonly performed procedures in orthopedics. In Poland we are observing significant changes in the age structure. With the prolonged life more and more elderly patients require musculoskeletal surgery to maintain comfortable and painless mobility. Reducing the duration of the procedure reduces the costs of anesthesiology, surgical and instrument teams, as well as the operating room technical team. The aim of the study was to compare the time required to perform hip joint arthroplasty by the direct anterior approach (DAA) with the postero-lateral approach (PLA) in our hospital. MATERIAL AND METHODS: A retrospective analysis of 559 total and bipolar cemented and cementless hip replacement procedures based on two operative approaches - the minimally invasive DAA over the course of 2 years, and the standard PLA over the course of 3 years - was performed. RESULTS: Statistically significant differences were observed between the approaches used for cementless total arthroplasty with regard to the mean treatment times: 51.9 min for the 272 DAA cases, and 78.3 min for the 190 PLA cases (p < 0.0001). For the cementless hemi-arthroplasty procedure, the mean treatment times were 46.9 min in 36 patients for DAA, and 48.2 min for 61 patients for PLA (p = 0.57). CONCLUSIONS: Minimally invasive DAA significantly shortens the time of the procedure in elderly patients compared to PLA. Further study is needed to analyze other aspects of those two approaches.

Neutrophil gelatinase-associated lipocalin, cystatin C and eGFR indicate acute kidney injury and predict prognosis of patients with acute pulmonary embolism.

OBJECTIVE: Risk stratification in acute pulmonary embolism (APE) includes the assessment of clinical status, right ventricular dysfunction and troponin concentrations. Since acute renal impairment is one of the important predictors of mortality in cardiovascular diseases, the authors hypothesised that it is an independent mortality marker in APE. MATERIAL AND METHODS: The authors observed 142 consecutive patients (52 M/90 F, 64±18 years) with APE diagnosed with contrast enhanced multislice CT. On admission, blood samples were collected for neutrophil gelatinase-associated lipocalin (N-GAL), cystatin C and creatinine assays. Estimated glomerular filtration rate (eGFR) was calculated using MDRD formula. RESULTS: Fourteen (10%) of 142 patients died by the 30th day of observation. eGFR≤60 ml/min was noted in 68 (48%) patients and eGFR≤30 ml/min in 11 (8%) patients. eGFR was higher in survivors than in non-survivors (66 (17-169) vs 46 (10-119) ml/min, respectively, p=0.02). In 80 (56%) patients, N-GAL was >50 ng/ml indicating acute kidney injury. N-GAL was higher in non-survivors than in survivors (88.8 (28.4-200.0) vs 53.0 (7.1-200.0) ng/ml, p<0.01). N-GAL level >50 ng/ml was found in 11 (79%) patients with fatal outcome. Area under the curve of N-GAL for all-cause mortality in ROC analysis was 0.715. N-GAL>75 ng/ml was present in 44 (31%) patients, while cystatin C >1900 ng/ml in 14 (10%) subjects. They showed sensitivity, specificity, positive predictive value and negative predictive value for prediction of all-cause death ((64%, 73%, 21%, 95%) and (36%, 91%, 30% 93%), respectively). N-GAL>75 ng/ml and cystatin C>1900 ng/ml increased the risk of death (HR 4.4 (95% CI 1.48 to 13.2, p<0.01) and 4.7 (95% CI 1.56 to 13.9, p=0.01), respectively). CONCLUSIONS: Acute kidney injury assessed by N-GAL occurs in 30% of APE and may contribute to the impairment of renal function present in half of them. Moreover, N-GAL, cystatin C elevation and low eGFR are associated with a poor 30-day prognosis in APE.

[Diagnostic techniques in breast cancer detection. Part III. The new cytobiological methods]. / Techniki diagnostyczne w raku piersi. Czesc III: Nowe metody biologiczne i genetyczne.

This publication contains an overview of the cyto-biological technologies utilized in breast cancer diagnosis. It refers to technologies created de novo and heralded as a breakthrough ones, as well as to those existing for years. An integration of new diagnostic biogenetic methods, with imaging techniques such as mammography, have become essential in order to cope with the requirements of early detection of breast tumours. Apart from the new and innovative diagnostic techniques, this publication also presents an outline of recommendations for genetic diagnostics as well as cooperative and multidisciplinary integrative activities, which are prerequisites for successful diagnosis and treatment and, consequently, longer survival periods upon which patients rely.

[Diagnostic techniques in breast cancer detection. Part II: Physical and biopsy methods]. / Techniki diagnostyczne w raku piersi. Czesc II: Metody fizyczne i biopsyjne.

This publication contains an overview of methods based on the principles of physics applied in breast cancer diagnosis. It refers both to those created de novo and those that have recently been updated, thanks to the revolutionary progress in digital, computer and information technologies. It also contains an overview of the biopsy techniques considered to be "the golden standard" in breast cancer diagnoses, as well as the latest ones, allowing to obtain ductal cells. An effort to develop new diagnostic methods, based on various fields of physics and integration of various diagnostic methods, needs to be made in order for medicine to cope with the requirements of early detection of breast tumours.

[Diagnostic techniques in breast cancer detection. Part I: imaging methods and their modifications]. / Techniki diagnostyczne w raku piersi. Czqsc I: Metody obrazowe i ich modyfikacje.

This publication contains an overview of the imaging techniques and the related technologies utilized in breast cancer diagnosis. It describes both those known for tens of years as well as the ones developed recently thanks to the new technological developments. An integration and coexistence of the diagnostic methods from classical mammography to the computerized laser mammography has become essential in order to cope with the requirements of early detection of breast tumours, which is a precondition of successful treatment and longer survival periods upon which patients rely.