Lung segments from anatomy to surgery.

Bronchopulmonary segments are of increasing interest to clinicians because surgical procedures are emerging that maintain as much pulmonary function as possible. The conventional textbook borders between these segments, their many anatomical variations, and their numerous lymphatic or blood vessels, make them challenging for surgeons, especially thoracic surgeons. Fortunately, because imaging techniques such as three-dimensional-computed tomography are developing further, we can see the anatomical structure of the lungs in detail. Moreover, segmentectomy is now seen as an alternative to a more radical lobectomy, especially for lung cancer. This review explores the connection between the anatomical structure of the lungs, especially their segments, and surgical procedures. Further research on minimally invasive surgical procedures is timely as we can diagnose lung cancer and other diseases ever earlier. In this article, we will look at the latest trends in thoracic surgery. Importantly, we propose a classification of lung segments in reference to surgery difficulties due to their anatomy.

Eosinophilic Esophagitis-What Do We Know So Far?

Eosinophilic esophagitis is a Th-2 antigen-mediated disease in which there is an influx of eosinophils to all layers of the esophagus, triggering an inflammatory response. Chronic inflammatory process causes esophageal remodeling, leading to difficulties in swallowing. Food impaction, heartburn, and chest pain are other characteristic (but not pathognomonic) symptoms in adults. Although the disease has only been described since in the early 1970s, its incidence and prevalence are rapidly growing, especially in Western countries. According to the diagnostic guidelines, there should be at least 15 eosinophils visible per high-power field in biopsies obtained from different sites in the esophagus upon endoscopy with relevant esophageal symptoms. Other diseases that can cause esophageal eosinophilia should be ruled out. Eosinophilic esophagitis treatment may be challenging; however, new methods of management have recently emerged. The currently used proton pump inhibitors, topical corticosteroids, and elimination diet are combined with biological treatment. New methods for disease diagnostics and clinical course assessment are also available. This review presents current knowledge about the disease, supported by the latest research data.

Effect of Total Ankle Arthroplasty and Ankle Arthrodesis for Ankle Osteoarthritis: A Comparative Study.

BACKGROUND Surgical methods in treatment of joint osteoarthritis (OA) aim at meeting the increasing expectations of people with active lifestyles. Ankle joint arthroplasty has been performed increasingly more often as an alternative to arthrodesis. The aim of this study was to compare arthrodesis and arthroplasty in the treatment of ankle osteoarthritis. MATERIAL AND METHODS The study involved 56 patients (45 males and 11 females) aged 21-72 years (mean 51) presenting with end-stage ankle OA: 29 patients (52%) underwent arthroplasty (Group A) and 27 patients (48%) underwent arthrodesis (Group B). Patients underwent surgery between 2004 and 2016 at a single clinical center. The observation period ranged from 6 to 150 months (mean 55 months). To assess the results of surgical treatment, quality of life (Health Assessment Questionnaire-HAQ, 12-Item Short-Form Survey-SF-12) and functional (American Orthopedic Foot & Ankle-AOFAS, Kofoed, Takakura) scores were used. For pain assessment, Visual Analog Scale was used (VAS). RESULTS After the surgery, group A and B had a statistically significant improvement in the joint function and pain relief according to AOFAS (A: 32.6 to 68.2; B: 27.4 to 61.3), Kofoed (A: 31.8 to 68; B: 25.9 to 60.3), Takakura (A: 30.6 to 62.9; B: 25.4 to 49.3), and VAS scores (A: 7.28 to 4.14; B: 7.33 to 3.78) compared with preoperative scores. After the surgery, quality of life scores improved in both groups, for HAQ (A: 0.91 to 0.53; B: 1.34 to 0.56) and for SF-12 (A: 26.6 to 36.8; B: 25.6 to 38.0). CONCLUSIONS The comparison of total ankle arthroplasty and ankle arthrodesis in treatment of end-stage ankle osteoarthritis did not reveal any significant differences.

Importance of Computed Tomography (CT) in Talar Neck Fractures. Case Studies.

Computed tomography is a modern technique producing high quality image of scanned organs. It plays a significant role in diagnostic work-up on orthopedics wards. This paper presents an analysis of management of two cases of Hawkins type I talar neck fracture with ankle joint rotation. In both patients, the diagnosis was based on conventional radiographs of the ankle joint in two projections and was subsequently verified with CT scans. The findings of a CT scan of the talus had a significant impact on further treatment and physiotherapy. Non-surgical treatment consisting in immobilization with a short leg cast combined with medication and magnetic field therapy produced a positive therapeutic outcome. A follow-up CT scan of the talus revealed bone union with remodelling in both patients. The functional outcome according to the AOFAS scale should be regarded good. Computed tomography is the radiological modality for detecting talar neck fractures and determining the presence of displacement. Follow-up CT scans evaluate the natural process of bone healing, which is crucial for treatment decisions regarding weight-bearing status. A correct diagnosis based on CT helps to prevent the development of necrosis and posttraumatic (secondary) degenerative changes as well as advanced physical disability, especially among youn-ger patients, in whom the injury is most common, consequently helping to avoid a long and costly treatment.

Ankle Osteoarthritis - Arthroplasty or Arthrodesis?

Osteoarthritis of the talocrural joint accounts for only 4% of cases of degenerative disease of the musculo-skeletal system. Unlike other joints, idiopathic OA of the ankle joint is identified in only 7% of patients. Until the end of the 1960's, arthrodesis was the treatment of choice in advanced OA of ankle joint. Absolute indi-ca-tions for arthrodesis include irreversible loss of joint anatomy, neurological conditions, advanced osteoporosis and chronic inflammation. Currently, the surgical treatment of ankle joint OA relies on third-generation endo-prostheses of the ankle. Arthroplasty is indicated in patients under 60 years of age with no history of non-ortho-paedic co-morbidities, engaging in little physical activity, with an intact joint axis and satisfactory mobility and non-smoking. This article analyzes the available literature on the results of surgical treatment in patients with osteoarthritis of the talocrural joint treated with arthrodesis or arthroplasty, taking into consideration the strict indications for each of these surgical methods.

Mortality as an indicator of treatment quality after pertrochanteric fractures in the elderly.

BACKGROUND: Fractures in people over the age of 65, especially pertrochanteric fractures of the femur, present a growing medical problem. Surgical treatment of such fractures should be performed in the shortest possible time after the accident. Efforts were made to answer the question what contributes to the reduction in mortality after pertrochanteric fractures. MATERIAL/METHODS: This work presents a comparative analysis of two populations treated surgically due to pertrochanteric fractures at the District Hospital of Orthopedic and Trauma Surgery in Piekary Slaskie during years 1988-1992 and 2005-2008. Patient mortality was used as an indicator of treatment quality. In the first group of 118 patients hospitalized in years 1988-1992, there were 48 deaths reported during 12 months after the surgery. In the second studied population of 244 patients (operated in years 2005-2008), 54 deaths were noted in the 12-month period after the surgery. There was a reduction in mortality from 40.6% to 22.3% over those 15 years. CONCLUSIONS: Introducing mortality as an indicator in the comprehensive assessment of treatment quality will intensify its monitoring in both the hospital as well as the out-of-hospital period of care. It will also reveal the individuality and social importance of geriatric fractures.