Influence of the method of TM joint total replacement implantation on the loading of the joint on the opposite side.

The temporomandibular (TM) joint is one of the most used joints in the human body, and any defect in this joint has a significant influence on quality of life. The objective of this study was to create a parametric numerical finite element (FE) analysis to compare the effect of surgical techniques used for total TM joint replacement implantation on loading the TM joint on the other side. Our hypothesis is that for the optimal function of all total TM joint replacements used in clinical practice it is crucial to devise a minimally invasive surgical technique, whereby there is minimum resection of masticatory muscles. This factor is more important than the design of the usually used total TM joint replacements. The extent of muscle resection influences the mechanical loading of the whole system. In the parametric FE analyses, the magnitude of the TM joint loading was compared for four different ranges of muscle resections during bite, using an anatomical model. The results obtained from all FE analyses support our hypothesis that an increasing extent of the muscle resection increased the magnitude of the TM joint overloading on the opposite side. The magnitude of the TM joint overloading increased depending on the muscle resection to 235% for bite on an incisor and up to 491% for bite on molars. Our study leads to a recommendation that muscle resection be minimised during replacement implantation and to a proposal that the attachment of the condylar part of the TM joint replacement be modified.

Individual replacement of the frontal bone defect: case report.

The objective of the skeletal defects reconstruction using individual implants is an attempt to replace lost and damaged anatomical bone structures, renew their original function, and at the same time, to restore the original aesthetic visual aspect. This work is focused on a demonstration of the design methods, fabrication and surgical techniques of the custom-made replacement of a large defect of the frontal bone on the skull. The patient was a 30-year-old woman with a defect of the frontal bone in the size of 7 x 3 x 2 cm after a serious polytrauma. The size and character of the defect excluded the use of commonly supplied augmentations. The geometry of the individual replacement was designed on the basis of a 3D model of the defect obtained from a series of CT scans. After verification of the shape accuracy of the defect made from plastic on a 3D printer, the individual replacement was fabricated from an ultra high molecular weight polyethylene (UHMWPE) by machining with the use of the CNC technology. The success of the augmentation depends on the accurate and precise fabrication of the individual replacement, which is highly demanding on the used advanced technologies.

Current issues of BPH treatment.

BPS is a disease with a negative impact on patient's quality not the quantity of life. Surgical treatment is still considered a gold standard, however, conservative treatment is an efficient and safe alternative with a positive impact on the quality of life.

[Acute conditions after kidney transplantation in patients with autosomal dominant polycystic kidney disease]. / Naliehavé situácie po transplantácii oblicky u pacientov s autozomálne dominantnou polycystózou obliciek.

There is a high risk of severe complications after kidney transplantation. In patients with autosomal dominant polycystic kidney disease (AD-PKD) the incidence of complications like ischaemic cardiac disease, acute myocardial infarction, pulmonary embolism, perforation of colonic diverticulosis is especially higher. The authors want to indicate another specific complication, rupture of the cyst of own polycystic kidney with retroperitoneal haemorrhage. Within the group of 658 patients who underwent kidney transplantation between January 1981 and January 2000 there were 54 (8.2%) patients with AD-PKD. Four patients with severe retroperitoneal haemorrhage due to rupture of the cyst of own polycystic kidney we present in a short case reports. All cases were fatal. Expect morphologic and functional follow up of the graft it is necessary to follow up polycystic kidney and indicate urgent nephrectomy in the case of any change.

[Laparoscopic fenestration of lymphoceles after kidney transplantation]. / Laparoskopická fenestrácia lymfokély po transplantácii oblicky.

Lymphocele is a relatively frequent complication after kidney transplantation, which impair the passage of urine from the kidney, cause emptying of bladder lymphoedemas of the lower limbs, etc. Percutaneous drainage of lymphocele is associated with a risk of infection and a high percentage of recurrence. Until recently, standard surgical treatment of this complication was open fenestration of the lymphocele into the peritoneal cavity. In their paper, the authors describe their first experience with laparoscopic fenestration of the lymphocele. From May 1998 till April 1999 the authors performed laparoscopic fenestration in 5 patients. In four patients the intervention was successful, in one female patient recurrence of lymphocele was observed, which was later resolved by an open operation. In none of the patients early or late surgical complications occurred, the use of analgetics during the postoperative period was minimal, the length of hospitalisation ranged from 2 to 4 days. The authors consider the discussed method a suitable alternative for treating lymphocele after renal transplantation thanks to its minimal invasivity. It involves practically no load of the sick patients after kidney transplantation.

The incidence of tumours in renal transplant recipients with long-term immunosuppressive therapy.

INTRODUCTION: The incidence of cancers after renal transplantation is significantly higher than in population that have not undergone transplantation. It is increased by a long-term survival of functional graft requiring long-term immunosuppressive therapy. MATERIAL AND METHODS: Since 1972, 620 renal transplantations have been performed for different causes of end stage renal disease. The authors report a group of 18 renal transplant patients (2.9%) who had cancer. Patients with malignancies are reviewed according to their age, sex, type of immunosuppression, interval between transplantation and the diagnosis of cancer, method of treatment and survival. RESULTS: All patients received cadaver kidneys, and secondary transplantation was performed in two patients. Five patients received conventional immunosuppression--azathioprine with prednisone, another 13 patients received cyclosporine with prednisone and/or azathioprine. In 13 males and 5 females (mean age 46.1 years) the malignant disease developed about 62.4 months after renal transplantation. Six patients had epithelial skin cancers (four of them had squamous cell carcinomas and two basal cell carcinomas). Two patients had breast cancer, colorectal carcinoma, renal cell carcinoma and bladder cancer, respectively, one patient had gastric cancer, thyroid carcinoma, carcinoma of tonsilla, and monocytic leukaemia with blastic transformation, respectively. The average survival of patients with malignancies was 20.3 months. Of 17 patients with cancer, 13 underwent surgical treatment, four patients with advanced disease received radiotherapy, hormonal treatment or only symptomatic therapy. In one patient the malignant disease was only discovered at autopsy. Five patients died of progressive malignant disease, four of intercurrent disease. Nine (50%) patients are alive, with no evidence of disease (NED), 31.9 months in average following the diagnosis of malignancy. Three patients returned to dialysis treatment, other 6 patients live with well functioning graft. CONCLUSIONS: In patients surviving long time after kidney transplantation the possibility of development of malignant disease should be considered. Preventive evaluation should guarantee early detection of cancer. Appropriate treatment, without cessation of immunosuppressive therapy, is indicated with the intention to prolong the patients' life with a functional graft and without dialysis treatment.

[Urinary oxalic acid excretion in chronic kidney failure and after kidney transplantation]. / Vylucovanie kyseliny oxalovej do mocu pri chronickom zlyhaní obliciek a po transplantácii oblicky.

Urinary oxalic acid excretion was examined in 61 patients with chronic nephropathies and in 21 patients after renal transplantation with a varying mean glomerular filtration. In both groups of patients a correlation was found between the plasma oxalic acid and serum creatinine and by a hyperbolic correlation between plasma oxalic acid and creatinine clearance. Moreover the authors found a direct correlation between oxalic acid and FEoxalic acid and FE(Na)+, FEH20 and FE1-ascorbic acid in both patient groups. Various chronic nephropathies and treatment in both groups did not affect the revealed correlations. In 13 healthy subjects during the period of maximum water diuresis urinary Na+ excretion did not increase but there was a significant increase of the l-ascorbic acid and oxalic acid excretion. In a group of 8 patients in the polyuric stage of chronic renal failure without dialysis treatment under conditions of increased dietary NaCl intake (15 g/24 h) a significant increase of the urinary Na+ excretion was recorded while the l-ascorbic acid and oxalic acid excretion was unaltered. From the assembled values of the examined biochemical indicators ensues that urinary oxalic acid excretion, similarly as ascorbic acid excretion, depended on water excretion.

[Erectile dysfunctions in patients treated with hemodialysis and kidney transplantation]. / Erektilné poruchy u pacientov liecených hemodialýou a transplantáciou oblicky.

The incidence of erectile dysfunction in patients suffering from severe renal diseases in the stage of renal insufficiency is significantly higher in comparison with healthy men of the same age. In the etiopathogenesis of erectile disorders, both organic and psychogenic factors participate in combination. By means of a questionnaire, the authors have collected information from 53 men treated by hemodialysis and kidney transplantation because of renal failure. Erectile disorders occurred in 41.5 per cent of men with chronic renal insufficiency. On one side hemodialysis improved the erectile dysfunction in two patients, in total, however, the incidence of impotence increased to 64.2 per cent. Erectile dysfunction was reported by 71.7 per cent of patients after kidney transplantation. The authors describe two cases of iatrogenic arterial insufficiency of the penis as the cause of impotence after secondary renal transplantation. In uremic patients as possible therapeutic methods, intracavernous application of vasoactive drugs or penile prostheses implantation should be considered. (Fig. 2, Ref. 20).

[Transurethral invaginating ureterectomy]. / Transuretrálna invaginacná ureterektómia.

The principle of transurethral invagination ureterectomy is in the invagination of the stump of the ureter its retraction into the urinary bladder and resection of the levels of the mucosa of the urinary bladder. The authors describe the surgical procedure and experience with the treatment of seven patients.

[Vitamin B12 and folic acid in chronic kidney failure and after kidney transplantation]. / Vitamín B12 a kyselina listová pri chronickom zlyhaní oblicek a po transplantácii oblicky.

Vitamin B12 in plasma, folic acid in plasma and erythrocytes were examined in 11 patients in the polyuric stage of chronic renal failure without dialyzation treatment, in 38 patients included in a long-term dialyzation programme before and after 3 months' oral administration of folic acid--(2 X 5 mg week)--and in 23 patients after transplantation of the kidneys. In none of the examined groups vitamin B12) and folic acid deficiency in plasma was detected. A reduced folic acid level in erythrocytes, but still in the reference range, was found in patients in the long-term dialyzation programme without supplementation. Supplementation with folic acid increased its concentration in plasma 4.5 times and in red cells 5.5 times. Haemodialysis did not influence the concentration of the examined indicators in plasma and red cells. According to the recorded results it is not necessary to supplement patients in long-term dialyzation programme and after renal transplantation with vitamin B12 and folic acid, if their dietary protein intake is not restricted.

[Antegrade pyeloureterography in the transplanted kidney]. / Antegrádna pyeloureterografia transplantovanej oblicky.

Antegrade pyeloureterography performed via fine puncture needle yields detailed imaging of the anatomy of the renal pelvis, calices, and ureter of the transplanted kidney. It is a simple and safe examination method providing information which, as a rule, can not be obtained by urography, radioisotope gammagraphy or ultrasonography. Puncture of the collecting system of the transplanted kidney with subsequent pyeloureterography is indicated for determining the site and nature of the obstruction in the ureter in urinary stasis in the transplanted kidney, for diagnosing urinary fistulas, for functional examination of the dilated upper urinary tract, as well as for percutaneous treatment of urological complications after kidney transplantation.

Results of renal transplantations performed at the Clinic of Urology in Bratislava.

From June 1972 to the end of 1983, 145 transplantations of cadaveric kidneys were performed at the Clinic of Urology in Bratislava. A clinical analysis of the first 110 renal transplantations is presented with regard to patients and allograft survivals and occurrence of surgical and urological complications.

Dynamics of serum minerals changes after renal transplantation.

In 27 patients surviving with transplanted cadaver kidneys for 12-107 months, calcium, phosphorus, magnesium and creatinine serum levels, glomerular filtration rate and incidence of serum mineral levels pathological deviations following renal transplantation were evaluated. In early posttransplantation period hypercalcemia and hypomagnesemia developed in one fourth of the observed group of patients and hypophosphatemia in two thirds of patients. Expressive hypermagnesemia developed in one patient. Calcium and phosphorus levels gradually normalized, excluding rare exceptions; magnesium serum level exceeded an upper limit of normal values in majority of patients, nor to medicamentous treatment was stated.

Transplantation of pediatric kidneys into adult patients.

The authors are dealing with the problems of transplantation of pediatric kidneys into adult recipients. Kidneys obtained from children who died 1-3 year old can be both transplanted into one adult recipient. The authors used this method in transplantation of kidneys from 2 - year old donor into adult recipient.

Operations in patients treated by regular haemodialysis.

Patients with chronic renal insufficiency treated by regular dialysis tolerate well surgical interventions provided they are appropriately prepared for the operation. It is first of all the management of symptoms of the uraemic syndrome by an effective dialysis, the follow-up during the operation and in the immediate postoperative period. On the basis of experience with 31 regularly dialysed patients, the authors have set their criteria for a total anaesthesia. Also the risks and the most frequent complications occurring during and after the operation are pointed out.