Type IV Titanium Hypersensitivity: Rare, or Rarely Detected?

The presented review aims to summarize the current knowledge of hypersensitivity to titanium - a material widely used in medical applications thanks to its exceptional chemical stability, resistance to corrosion, low specific weight and high strength. The hypersensitivity to metals is usually caused by the Type IV immunopathological reaction. Case reports on allergic reactions to titanium are rare but the actual occurrence can be expected to be much higher, especially due to its problematic detection. Although cutaneous patch tests are widely accepted and used for the diagnosis of hypersensitivity of numerous metals (e.g. Ni), it is notoriously unreliable in case of allergies to titanium, which may be associated with the low percutaneous transport of titanium and its salts. The Lymphocyte Transformation Test has superior sensitivity but it remains mostly unknown among clinicians and there are not many laboratories capable of performing it. This review presents numerous case reports indicating, in combination with the above-mentioned facts, that hypersensitivity to titanium should be considered as a possible cause also in non-specific problems associated with titanium implant failure. Key words: titanium, allergy, patch test, lymphocyte transformation test.

5th Metatarsal Jones Fracture - To Treat Conservatively, or Surgically Using Headless Double-Threaded Herbert Screw?

PURPOSE OF THE STUDY Fifth metatarsal fractures, in particular so-called Jones fractures, are relatively common injuries both in the general population and athletes. Although discussions about whether the surgical or conservative solution should be preferred are ongoing for decades, there is no clear consensus. Here, we aimed to prospectively compare the results of osteosynthesis using the Herbert screw with the conservative solution in patients from our department. MATERIAL AND METHODS Patients 18-50 years presenting to our department with Jones fracture and meeting further inclusion/exclusion criteria were offered participation in the study. Those willing to participate signed informed consent and were randomized by flipping the coin into surgically and conservatively treated groups. After six and twelve weeks, X-ray was performed in each patient and AOFAS score was determined. Conservatively treated patients who showed no signs of healing and whose AOFAS was below 80 after six weeks were offered surgery again. RESULTS Of 24 patients in total, 15 were assigned to the surgically treated group and nine were treated conservatively. After six weeks, AOFAS score of all but two patients (86%) in the surgically treated group ranged between 97 and 100, while this score exceeded 90 points only in three patients (33%) from the conservatively treated group. On X-ray, successful healing after six weeks was observed in seven patients (47%) from the surgically treated group but in none of the patients from the conservatively treated group. Three out of five patients in the conservative group whose AOFAS was below 80 after six weeks opted for surgery at that time and all improved significantly by the twelfth week. DISCUSSION Although studies on surgical treatment of Jones fracture using various screws or plates are not rare, we present an uncommon method of surgical treatment of this injury - the use of the Herbert screw. The results of this method are excellent and even on a relatively small sample yielded statistically significantly better results than conservative treatment. Moreover, the surgical treatment facilitated early loading of the injured limb, which allows an earlier return of the patients to normal life. CONCLUSIONS Osteosynthesis using Herbert screw in Jones fracture yielded significantly better results than conservative treatment. Key words: Jones fracture, AOFAS, Herbert screw, 5th metatarsal fracture, surgical treatment.

Correlations between selected parameters of nasal cavity in neonates and young infants - computed tomography study.

BACKGROUND: Correlations between selected metric parameters of the nasal cavity and nasopharynx in children without atresia may be useful for anticipating probable dimensions of this region in living subjects, in terms of changes with age. MATERIALS AND METHODS: One hundred and eighty children, age range 0-3 years, were divided into five age groups, and measurements of 18 distances between structures of nasal cavity and nosopharynx were performed on computed tomography scans. Correlation coefficients and relations between parameters have been determined. RESULTS: Our study confirmed the existence of statistically significant correlations between linear dimensions within nasal cavity in children. The analysis demon-strated that for the values of following indexes: nasal septum length/piriform aperture width, and maximum length of the nasal septum/posterior nares width no statistically significant differences have been noted between age groups of children. All correlations have been positive. No statistically significant differences have been noted between the maximum width of the vomer and osseous parameters measured, both in the anterior and posterior part of the nasal cavity, and nasal septum length. CONCLUSIONS: The size of posterior nares changed with age in children by a constant value. So far, no such an analysis has been carried out assessing potential correlations between linear dimensions for the entire nasal cavity, nasopharynx, length of the nasal septum in children, as well as proportions of individual linear dimensions of the anatomical structures analysed, in various age groups.

Traumatic rupture of the aorta in adolescence--description of two cases.

Aortic disruption is a well documented cause of death in motor vehicle accidents and falls from heights. These injuries also affect children. About 10 % who survive despite aortic injury could potentially be saved provided the diagnosis is established and surgical intervention is undertaken early enough. We present here 2 cases of adolescents aged 17 years, treated in our hospitals with different results. In the first case, timely diagnosis of aortic pseudoaneurysm could not be made, which resulted in its rupture and the death of the patient. In the other patient an early diagnosis of aortic injury was established already in the Emergency Department. The patient was then transferred for further surgical treatment which proved successful. Diagnosis of traumatic aortic rupture is impossible at the accident site and can also be missed in hospital. The symptoms of aortic rupture are not characteristic. The knowledge of the mechanism of injury is extremely important. The diagnosis is established based on chest X-ray, computed tomography, and transoesophageal echocardiography. In cases of doubt, aortography remains decisive in the identification of an aortic injury.

Beta-blocking agent facilitating the spontaneous passage of ureteral stones.

Based on data from neurophysiological studies, the author checked the action of a beta-blocking agent facilitating spontaneous stone passage from the ureter. Experience has shown that, compared with the control group, the beta-receptor-blocking agents proved to be useful in the facilitation of a spontaneous discharge of stones located in the lower part of the ureter.

Screening the familial accumulation of kidney malposition and malrotation.

Sacral dystopic kidneys have been found in a couple of brothers and sisters. By screening all the first-grade relatives in one generation, 5 brothers and sisters showed kidney malposition and malrotation. This is the first report in the literature about family screening for this developmental anomaly. Based on the results an autosomal recessive character of the clinical pattern was suggested; it is pointed out that the final clearing of the hereditary process requires further family screenings.

[Uterine and bladder prolapse causing kidney damage]. / Durch Gebärmutter- und Blasenprolaps verursachte Nierenschädigung.

A case of severe renal disturbance caused by uterine and bladder prolapse was observed and successfully treated by vaginal operation. Among the surgical indications of vaginal prolapse the lesions of the urinary system must also be considered.