[Vertical Talus: Mid-Term Results of Surgical Therapy]. / Vertikální talus: strednedobé výsledky operacní terapie.

PURPOSE OF THE STUDY: The aim of the study was to clinically and radiographically evaluate the results of a two-stage surgical technique used in our department to treat congenital vertical talus. MATERIAL AND METHODS: In the years 1990-2010 we treated eight patients (nine feet). We used a two-stage surgical technique, with lengthening of the dorsiflexor muscles of the leg and the tibialis anterior muscle at the first stage. This was followed by cast fixation with the ankle in plantar flexion for 6 weeks. At the second stage, through a Cincinnati approach, the talonavicular and calcaneocuboid joints were reduced and the Achilles tendon and peroneal tendons were elongated. Two patients underwent the Grice extra-articular subtalar arthrodesis at the third stage. The post-operative outcomes were assessed based on radiographic findings of dorsoplantar views of the talocalcaneal angle (TC AP) and talar axis-first metatarsal base angle (TAMBA AP), lateral views of the weight-bearing talocalcaneal angle (TC LAT), talar axis-first metatarsal base angle (TAMBA LAT) and talotibial angle (TT). In all patients but one who was lost to follow-up, the radiographic and objective findings were evaluated with the 10-point scale described by Adelaar et al. RESULTS: The average follow-up was 8 years and 9 months. All radiographic findings showed improvement in all angles measured. The pre-operative values decreased in TC AP from 64.2° to 27.6°; in TC LAT from 48.8° to 30.4°; in TT from 158° to 109.3°; in TAMBA AP from 54.7° to 17.4°; in TAMBA LAT from 57.3° to 5.7°. The Adelaar scoring system was employed in seven patients of whom three had excellent, three good and one fair results. Two patients required additional surgery due to recurrence of the deformity DISCUSSION: Studies in recent years have shown a gradual diversion from extensive surgical procedures and a trend toward techniques like manipulation, serial casting application and minimal surgical intervention with talonavicular reduction and fixation. The Dobbs technique has so far shown good results but no long-term results have yet been available and therefore the number of recurrent cases is not known. CONCLUSIONS: The two-stage surgical technique used in our department proved to be very successful in a long-term follow-up, but the group of patients was too small to provide conclusive evidence. However, benefits of this technique are clearly apparent from the post-operative radiographic and objective findings assessed as very good.

Application of low-cost Gallium Arsenide light-emitting-diodes as kerma dosemeter and fluence monitor for high-energy neutrons.

Displacement damage (DD) caused by fast neutrons in unbiased Gallium Arsenide (GaAs) light emitting diodes (LED) resulted in a reduction of the light output. On the other hand, a similar type of LED irradiated with gamma rays from a (60)Co source up to a dose level in excess of 1.0 kGy (1.0 x 10(5) rad) was found to show no significant drop of the light emission. This phenomenon was used to develop a low cost passive fluence monitor and kinetic energy released per unit mass dosemeter for accelerator-produced neutrons. These LED-dosemeters were used to assess the integrated fluence of photoneutrons, which were contaminated with a strong bremsstrahlung gamma-background generated by the 730 MeV superconducting electron linac driving the free electron laser in Hamburg (FLASH) at Deutsches Elektronen-Synchrotron. The applications of GaAs LED as a routine neutron fluence monitor and DD precursor for the electronic components located in high-energy accelerator environment are highlighted.

Bronchial brushing during fiberoptic bronchoscopy for the cytodiagnosis of lung cancer: comparison with sputum and bronchial washings.

In a study of 50 cases of bronchogenic carcinoma in which brushings and washings during fiberoptic bronchoscopy, as well as sputum cytopathologic examinations were performed in the same patients, accuracy rates were respectively: 76 per cent, 76 per cent and 56 per cent. The main cytologic differences setting brush apart from wash and sputum specimens referred to the arrangement of tumor cells as well as the distribution of chromatin within their nuclei. These differences appeared related to cell degeneration which was minimal in brush materials and maximum in sputum specimens. Only six cases were assigned a different cell type of bronchogenic carcinoma when brush cytopathologic diagnoses were compared with results obtained by biopsy or lobectomy specimens. Our findings are consistent with the view that the brush technique is very accurate for the cytodiagnosis of lung cancer and becomes also rather specific once cytologic characteristics of the fresher samples obtained become familiar to the cytopathologist. Non-observance of the special characteristics of these better preserved cellular samples is the major pitfall as to diagnosing, cell typing and judging degree of differentiation of bronchogenic carcinoma in brush cytology specimens.

[Conservative treatment of femoral fractures in children in data from the Orthopedic Clinic of the 2nd Medical Faculty of Charles University]. / Konzervativní lécení zlomenin detského femuru v materiálu Ortopedické kliniky 2. LF UK.

PURPOSE OF THE STUDY: Conservative therapy is the method of choice for treating femoral fractures in younger children all over the world. At the Department of Orthopedic Surgery of the Second Faculty of Medicine, Charles University in Prague, this approach has had a long tradition and has only partly been replaced by other, more recent methods. It is not always necessary to abandon well-established and reliable techniques because of new achievements and this is demonstrated by the results of our study. MATERIAL: In a period of 22 years, 112 boys and 97 girls were treated by Bryant's traction and 62 boys and 46 girls by Weber's traction. The former was used in children younger than 5 years, weighing less than 20 kg. The latter was applied in patients between 5 and 10 years of age whose body mass was between 20 to 35 kg. METHODS: Bryant's traction, used in the younger age category, offered the advantage of easy application without total anesthesia. Both legs were suspended in an apparatus that keeps the patient's pelvis slightly elevated above the bed level. Counter traction was provided by the weight of the suspended pelvis. In Weber's traction, used in children aged 5 to 10 years, a Kirschner's wire was inserted in the distal metaphysis of each femur in the frontal plane. The ends of each wire were attached to a metal U-shaped spreader. This apparatus holds the legs at right angles both in the knees and hips. Each patient was examined by X-ray at 1 week to check the correction of displacement and at 3 weeks to check callus development. All the patients were immobilized in a plaster cast spica for a period of 6 to 8 weeks after injury and each child was also shortly hospitalized for cast removal and early physical therapy. RESULTS: Fractures in the middle of the diaphysis with an oblique fracture line were most frequent. These and long spiral fractures responded well to these two methods in almost all cases. In transverse fractures, which are less common, when an angular dislocation persisted it was tolerated owing to the subsequent remodelation. The most serious complication was a shortening of the leg involved, which often occurred with the use of Bryant's traction. The shortening was found in 80% of the patients shortly after the fracture had healed. A low body mass of the child was generally responsible for failure to stretch the femur to its full length. In children treated by Weber's traction, the shortening was observed in 55% immediately after fracture healing. On examination at 1 and 3 weeks, its presence was markedly lower, occurring in 25% and 17% of the children, respectively. Lengthening was found only occasionally on examination in adolescence or adulthood, but this may have been due to other causes. Excessive movement of the child in bed, usually when the parents came to visit, sometimes interfered with good correction of the displacement. DISCUSSION: Bryant's traction was used in our department for conservative treatment even in very young children. The plaster cast spica was applied primarily to non-displaced fractures. Pavlík's harness, recommended by Rockwood and Stannard, was used in pediatric injuries only occasionally. When conservative treatment was indicated in older children, Weber's traction was applied. The Göteborg traction described by Havránek was not used. The shortening of the leg treated was the most frequent complication, but our results were not in agreement with the data reported by Stahelim, who described a greater and more frequent shortening in children older than our patients. In our study, younger children suffered from leg shortening more often, as was also reported by Náhoda and Stryhal. The subsequent lengthening was found only occasionally; the average values of 2.6 cm and 2.3 cm in younger and older children, respectively, as reported by Náhoda and Stryhal, were not recorded. When lengthening was observed, its value was always lower. A 30 degrees rotational deviation, observed by Verbeek in one third of his patients, was not seen in our children. Pseudoarthrosis or infection were absent in our population and a literature search showed that, when treated conservatively, femoral fractures were not associated with these complications. CONCLUSIONS: Well-established methods of conservative treatment of femoral fractures in children were evaluated with the objective to advocate their importance for today's orthopedic surgery. Although the children treated by these methods are confined to bed for a longer period than when more recent techniques are used, they may avoid many of the complications that accompany these new approaches.

[Arthroscopy of the knee joint in childhood]. / Artroskopie kolenního kloubu u pacientu detského veku v nasem souboru.

PURPOSE OF THE STUDY: Arthroscopy is generally regarded as a method suitable exclusively for the treatment of adult patients and only occasionally used in children as a diagnostic tool. Since the number of arthroscopic procedures has considerably increased in recent years, we decided to evaluate the knee arthroscopies performed in pediatric patients, focusing on a correlation between the preoperative diagnosis and arthroscopic findings. MATERIAL AND METHODS: The clinical records on 319 arthroscopic procedures in 311 children treated at our Department between 1995 and 2002 were retrospectively analyzed. The procedures were evaluated in view of the diagnosis established before surgery and that confirmed by arthroscopy. The patients were placed in two groups: preadolescents (younger than 13 years) and adolescents (13 to 18 years old). All patients were treated by the standard arthroscopic procedure. Except for two patients, all children underwent elective surgery of diagnostic or therapeutic reasons. RESULTS: Mediopatelar plica was the most frequent pathology and was treated in 26% of the patients. Meniscus lesions were found in 35% of all patients, but were more frequent in the adolescent group, in which two thirds of all patients were treated for this condition. The crucial ligaments were affected in 10% of all patients. In 52 patients, no pathology was found on arthroscopic examination. There was no difference in findings between the two groups. DISCUSSION: In some patients, the arthroscopic findings differed from the diagnosis established preoperatively, with the pathological condition being misdiagnosed more often in the adolescent group. The correct diagnosis was confirmed in 81.4%. The findings were negative in 16.4% of the patients, which is in agreement with the literature data. CONCLUSIONS: Based on our experience we conclude that great caution be exercised when making the preoperative diagnosis. The expertise of the diagnosing physician and availability of feedback are emphasized.

Note: measurement of extreme-short current pulse duration of runaway electron beam in atmospheric pressure air.

This note reports the time-amplitude characteristic of the supershort avalanche electron beam with up to 20 ps time resolution. For the first time it is shown that the electron beam downstream of small-diameter diaphragms in atmospheric pressure air has a complex structure which depends on the interelectrode gap width and cathode design. With a spherical cathode and collimator the minimum duration at half maximum of the supershort avalanche electron beam current pulse was shown to be ~25 ps. The minimum duration at half maximum of one peak in the pulses with two peaks can reach ~25 ps too.