A New Method of Evaluating the Symmetry of Movement Used to Assess the Gait of Patients after Unilateral Total Hip Replacement.

PURPOSE: We propose a new concept of symmetry, the symmetry function, as a continuous function of the percentage of differences between sides of body movement and normalised throughout the whole range of motion. The method is used to assess the dynamical symmetry of gait of patients after unilateral total hip replacement (asymmetric group) and healthy people (symmetric group) and also to reveal discrepancies between normal and abnormal movement patterns. METHODS: The gait of twelve male patients (49.7 ± 2.8 y), six weeks after unilateral total hip replacement (uTHR), was analysed against the gait of thirteen healthy men (36.1 ± 3.1 y). The speed of healthy men was matched to the speed of the patients. Comparison of the affected limb in uTHR patients with the healthy limb of able-bodied men was carried out on the basis of the highest symmetry values in the sagittal plane. RESULTS: In uTHR patients, the symmetry function provides information on the symmetry of movements in the whole range of motion in contrast to symmetry indices which are calculated for selected parameters or peak values. Research revealed average asymmetric discrepancies for pelvic tilt up to 250% for the entire gait cycle with a peak of approx. 400% at the end of the loading response and terminal swing phases. Asymmetry of gait observed in other joints was below 200% of the mean range of motion. CONCLUSIONS: Regions of the greatest asymmetry in pathological movements are usually different from the region of the greatest range of motion. Therefore, it is insufficient to measure symmetry only for selected regions during motion. The symmetry function is a simple method which can complement other robust methods in time series data evaluation and interpretation.

The Use of Basket and Cross Shell Reinforcement in Revision Acetabulum Arthroplasty.

BACKGROUND: In spite of many decades of experience and huge data resources to evaluate the results of increasingly difficult and extensive acetabulum revision operations, it is not possible to obtain fully satisfactory results. This article presents the indications for use, surgical technique, and distant and intermediate-range results in the operation of replacing a loosened acetabular component of an endoprosthesis with accompanying extensive cavitary or segmental floor defects. MATERIAL AND METHODS: A retrospective evaluation was performed on 65 hips in 55 patients, including bila-teral procedures in 8 women and 2 men, operated on between 1994 and 2012. The mean age of the patients at the time of surgery was 66 +/- 16 years. The average duration of follow-up was 9 years and 3 months. RESULTS: Clinical results at 36 months from the surgery showed that the Harris Hip Score had increased by a mean of 47.2 HHS points and the WOMAC index had increased by 37.7 points. CONCLUSIONS: 1. The use of the method described in the article in selected cases produces good and excellent results, especially with the use of double reinforcement. 2. A basic prerequisite for the use of the basket is stable support for at least 3 arms of the basket on the acetabular bone reinforcement ring and good protection of grafts in the bone stock with sufficient biological capacity.

Disseminated Infection of Encephalitozoon cuniculi Associated With Osteolysis of Hip Periprosthetic Tissue.

Background: Among patients with hip joint endoprosthesis, periprosthetic osteolysis is the most common complication following primary arthroplasty, and subsequent implant loosening is the leading cause of arthroplasty revision. Causes of stability loss, though not always evident, can be mechanical, allergic, or infectious (bacterial and fungal agents) in nature. Microsporidia, widespread opportunistic fungal pathogens that infect most human tissues, are a potential infectious cause of stability loss. Infections caused by Encephalitozoon species-one of the most common microsporidial pathogens in humans-primarily localize to intestinal and respiratory tracts, but can disseminate to tissues throughout the body. Methods: We examined 53 immunocompetent patients, 23 after revision and 30 after primary hip arthroplasty, for infection by Encephalitozoon species. Periprosthetic tissue, urine sediments, and stool samples were tested by microscopic examination and genus-specific nested polymerase chain reaction followed by genotyping. Results: Ten patients had Encephalitozoon-positive periprosthetic tissues, 9 (39%) after revision and 1 (3.3%) after primary hip arthroplasty. Among the tissue-positive postrevision patients, 7 had a positive urine sample and 1 had a positive stool sample. Encephalitozoon cuniculi genotype II was identified in 88.8% (16/18) of samples. Two urine samples were positive for a novel Encephalitozoon species. Conclusions: Encephalitozoon cuniculi should be considered as a cause of osteolysis in hip periprosthetic tissue, leading to a loss of implant stability.

Surgical Strategy in Intra-pelvic Cup Migration During Total Hip Arthroplasty. A Case Study.

We report the case of a 63-year-old female patient referred to our department due to an early postoperative complication resulting from intraoperative fault. During the preparation of a bone socket for the acetabular cup, the acetabular fossa was broken, forming an extensive segmental defect of the diameter of the reamer used. An attempt to stabilize the acetabular prosthesis using bone cement without repairing the bone defect was ineffective and inappropriate. During the deposition of the acetabular prosthesis on the cement, much of the cement was pushed beyond the outline of the bony acetabulum. Progressive early migration of the acetabular cup together with the cement due to the non-implementation of rapid intervention led to their displacement into the abdominal cavity. On analysing a radiograph performed 3 months after the operation, we decided to adopt a two-stage surgical strategy. In the first stage, the acetabular prosthesis with the cement was removed from a retroperitoneal approach. Three weeks later a revision arthroplasty of the acetabular component was carried out with reconstruction of the acetabular floor.

[Significance of biomechanical criteria in proper treatment planning in knee osteoarthritis].

Introduction: Following the established and unequivocal criteria when choosing the treatment of knee osteoarthritis, despite possibility of precise imaging, is still very problematic. This is partly because doctors of different disciplines: general practitioners, orthopaedic surgeons, rheumatologists, physiotherapists, are involved in the treatment of this disease. For most of them the basic criteria to implement the treatment are: pain and assessment of X -ray in the supine position. As a result of that, despite slight and doubtful improvement, treatment is improperly targeted and extended. The aim of the study was to prove that the correct diagnosis, including biomechanical characteristics of the affected limb, choice of correct treatment, and observance of indications, can shorten treatment, make it more efficient and less expensive. Material and methods: We analyzed of 103 patients qualified for total knee arthroplasty between 2006 and 2011. The indication was primary and advanced knee osteoarthritis in phases III and IV according to Ahlbäcka scale medial displacement of mechanical axis deviation in the lower limb with club- -foot (I to IV degrees) and with centre of rotation of angulation (CORA) in the proximal part of the tibia. Only subjects with body mass index under 25 were included in the study. Surveys were used to assess the pre -operative duration of illness, non-surgical methods of treatment and their effects. Final evaluation was made using the Visual Analogue Scale (10 -degrees) of pain (during the effort and rest) and gait efficiency 30 days after completed treatment. Results: The 66.5% of patients showed no significant improvement in all assessed parameters, which would justify to continuation of the therapy as described above.

Assessment of gait after bilateral hip replacement. Case study.

Total hip arthroplasty (THA) is one of the most effective methods of treatment of severe hip osteoarthritis (HOA). In many cases pathological gait patterns persist despite properly conducted surgery and disturb the normal wear of the artificial joint surfaces. The aim of the study was to conduct functional and biomechanical assessment of gait in a patient after bilateral THA due to severe degenerative changes in the hip. The assessment focused on the gait parameters which significantly deviate from a normal gait pattern at various stages of treatment. Physiotherapeutic assessment of the patient included measurements of the range of motion in lower limb joints, the Timed Up and Go test, and pain assessment. Biomechanical assessment involved measurements of spatiotemporal gait parameters and the dynamic range of motion using BTS Smart-E motion analysis system. Although clinical examinations after both the first and second procedure suggested recovery of the patient's physical function, biomechanical assessment of her gait after the second procedure indicated the presence of deviations from a normal gait pattern. Secondary to a limited range of internal/external hip rotation, extension, and abduction, corresponding indices were still in the pathological range.

Prevalence of Demodex spp. in eyelash follicles in different populations.

INTRODUCTION: The pathologic relevance of Demodex infestation in blepharitis is still controversial. The aim of the study was to determine the prevalence of Demodex spp. in eyelash follicles and its relationship to eye symptoms. MATERIAL AND METHODS: A total of 290 individuals were studied for the presence of Demodex folliculorum and Demodex brevis within eyelash follicles. Participants belonged to one of four groups: inpatients, drug abusers, health professionals, and medical students. Ten eyelashes were epilated from each subject, placed on microscope slides and examined for parasites. The sample was defined as positive if at least one parasite or parasite's ova were present. The presence of parasites was analyzed according to age, gender, place of living, reported eye problems, and use of contact lenses or glasses. RESULTS: The prevalence of Demodex spp. infestation among all studied subjects was 41%, with the highest infestation rate among inpatients (p < 0.01) and elderly people (p < 0.001). No difference regarding the presence of Demodex was found between women and men (p = 0.76). Demodex folliculorum was about 2.4 times more frequent than D. brevis. The prevalence of Demodex spp. in subjects with and without eye complaints suggesting blepharitis was similar (41.6% vs. 40.2%, respectively, p = 0.9). On the other hand, wearing glasses was linked to Demodex infestation (48.4% vs. 32.3%, p < 0.01). CONCLUSIONS: Demodex is a common saprophyte found in human eyelash follicles. Its presence might be related to some ocular discomfort; however, in the vast majority of cases the infestation seems to be asymptomatic.

Assessment of strength & velocity parameters of hip joint muscles in rehabilitation of a patient with lower limb amelia. Case study.

We studied a 19-year-old patient with congenital partial absence of certain left lower limb structures (amelia) with no additional developmental defects. The patient had no fibula or foot bones and the tibia was reduced to 3 cm, which made it impossible to use a crural prosthesis. The aim of the study was to assess the strength capacity of muscles influencing the ipsi- and contralateral hip joint in the amelic patient. Compared to healthy individuals, patients with a congenital absence of lower limb demonstrate a marked disproportion in muscle peak torque between hip flexors and hip extensors, which may lead to damage to the weaker muscle group. The disproportions may be reduced with a rehabilitation programme aimed to strengthen the hip joint extensors.

Analysis of the influence of a metha-type metaphysical stem on biomechanical parameters.

The full postoperative loading of the limb is possible if patients are properly selected and qualified for hip arthroplasty and the requirements as to the proper position of the metaphysial stem are met. The lack of precision, and patient qualification which does not satisfy the fixed criteria may result in stem setting inconsistent with the assumptions. An analysis based on the finite element method (FEM) will enable one to find out how to plan the magnitude of operated joint loading on the basis of the position of the stem in the postoperative radiograph. By analyzing the distribution of bone tissue deformations one can identify the zones where the spongy bone is overloaded and determine the strain level in comparison with the one determined for a model of the bone with the stem in proper position. On the basis of the results obtained one can estimate the range of loads for the operated limb, which will not result in the loss of the stem's primary stability prior to obtaining secondary stability through osteointegration. Moreover, an analysis of the formation of bone structures around the stem showed that the incorrect setting of a Metha-type stem may lead to the initiation of loosening.

The first Polish total laryngectomies.

The total removal of the larynx (total laryngectomy), performed in 1872 by the well-known Viennese surgeon Christian A. Theodor Billroth (1829-1894), was an epoch-making event in the history of surgery and laryngology. This paper presents the first surgeons who performed this operation. The first Pole who performed a total laryngectomy (1877) was Julian Kosinski (1833-1914), head of the Surgical Clinic of Imperial University Warsaw. It was the 14(th) operation of this kind in the world. Several laryngectomies were carried out by Franciszek Ksawery Jawdynski (1851-1896), called the father of Polish head and neck surgery, who was the first Pole to excise a malignant neck cancer together with the lymph nodes. The next total laryngectomies were performed by the following Polish surgeons: Jan Mikulicz-Radecki (1850-1905), Wladyslaw H.S. Krajewski (1855-1907), Alfred Obalinski (1843-1898). According to Jan Sedziak, by 1897 Poland with 16 laryngectomies (per 188 carried out) had occupied the fourth position in the world. The failures of the first laryngectomies were due to such factors as the ignorance of shock pathophysiology, the inability to ensure the patency of the airways during and after the operation, which would result in lung and mediastinum infections, massive haemorrhages and so on. But the primary cause was the lack of constructive collaboration between the laryngologists and the surgeons.

[The development of treatment in the Birstonas health resort up to 1939 and the physicians of Birstonas in the 19th and first half of the 20th century]. / Rozwój lecznictwa uzdrowiskowego w birsztanach do 1939 roku. birsztanscy lekarze W XIX i pierwszej polowie XX wieku.

First of all, the history and development of Birstonas, a health resort by the river Neman, near Vilnius, first mentioned in 1382, are recounted in detail. The value of this health resort was determined by a mild climate and salt springs. Information on Birstonas by Wladyslaw Syrokomla (1823-1862), the Polish poet, and Zygmunt Gloger (1845-1910), the Polish ethnographer, archaeologist and historian are well known. The indications and contraindications in many diseases, and the effects of treatment in this health resort are described. Finally, the opportunities for recreation and the attractions in this charming health resort are presented. Attention was paid to the leading role of Poles in the development of this health resort now in Lithuania. The biographies of several physicians practicing in Birstonas: Jan Sokolowski, Aleksander T.W. Korewa, Anicety Renier, Stanislaw K. Wikszemski, Benedykt Bilifiski, Erminio Andriolli, Roman Przybylski and Pawel A. Sawicki are presented. Their biographies, professional achievements and work in Birstonas are depicted in detail.

[The development of treatment in a health resort in Niemirow until the end of the second republic]. / Rozwój lecznictwa uzdrowiskowego w niemirowie do konca drugiej rzeczypospolitej polskiej.

The history ofNiemirów, a health resort on the south-eastern borderland of Poland is recounted in full particulars first of all. A mild climate, charming regions, natural stuffs (sulphuric-alkaline salt springs and therapeutic mud) formed the status of this health resort. The indications and contraindications in many diseases and effects of treatment in a health resort are described. The bats in Niemirów and fixtures are presented widely. The chances of recreation and attractions in this health resort are presented finally.

Professor Ludwik Hirszfeld in his relations with students and junior researchers.

This paper presents a profile of Ludwik Hirszfeld (1874-1954) as an educator of medical personnel. Hirszfeld was an eminent immunologist, bacteriologist and seroanthropologist; the originator of the Polish school of immunology; a professor at Warsaw University, Maria Sklodowska-Curie University in Lublin and the University and Technical University in Wroclaw; and the founder of the Institute of Immunology and Experimental Therapy in Wroclaw. An account of his relations with university students and junior research personnel - relations based on respect, on multi-faceted assistance in everyday life, but above all on a love for science - is presented, depicting Hirszfeld as a teacher of scientific thinking.

Achievements of Polish doctors in gastrodiaphanoscopy at the turn of the 19(th) and 20(th) centuries.

Diaphanoscopy/transillumination, the method of shining a bright light through tissues, was devised in the mid-19(th) century and developed after the invention of the light bulb by T.A. Edison. Benjamin Milliot was the first to examine the stomach by means of an incandescent platinum wire. The experiments conducted by Max Einhorn using a device consisting of a Nelaton catheter with an inserted light bulb, were valuable. In Poland the method of gastrodiaphanoscopy was popularized by Teodor Heryng, Mikolaj Rejchman and by Warsaw doctors. They used a diaphanoscope consisting of a gutta-percha probe distally equipped with a metal attachment with a light bulb hidden in it and with a so-called cooling device. The examination would usually be conducted in the standing position after the stomach had been filled with water. Light patches corresponding to the stomach's lower and side boundaries would be obtained. Rejchman's observation, that such a contractile and flexible organ as the stomach, changing its volume and position, is bound to change its light image, was correct. Heryng's and Rejchman's research inspired the foreign researchers Renvier, Leopold Kuttner and John Jacobson. Extensive research was subsequently conducted by C.A. Meltzing and Wilhelm Schwartz. Diaphanoscopy would also be performed by Walery Jaworski, the pioneer of gastrology. He was particularly interested in transillumination of the stomach, peritoneum and omentum tumours. Eugeniusz Kozierowski, a practicing physician from Gorlice, diagnosed neoplastic pylorostenosisusing this method. Gastrodiaphanoscopy is a historical method, now of no value against gastroendoscopy and the state-of-the-art methods of image diagnostics.

[The past of Druskininkai (part I)]. / Z przeszlosci Druskienik (czesc I).

The development of hydrotherapy in the first half of the XIX century is presented in short. The geographical, climatic and epidemiological situation of Druskininkai, a health resort founded in 1837 has been mentioned. The natural substances: salt springs and therapeutic muds are described sufficiently. The development of the health resort in the XIX and the first half of XX century has been recounted. The physicians Ksawery Wolfgang (?-1864), Ludwik Zembrzycki, Izydor Nahumowicz (1800-1842), Anicety Renier (1804-1877), Kazimierz Choiski (1814-1882), Jan Pilecki (1821-1878), Józef Markiewicz (1834-1923), Walery Bujakowski (1857-1919) and the others and local rich gentry played an important role in the development of Druskieniki. The physician was undoubtedly the most esteemed person-age of this health resort. Russification of this health resort on the turn of the XIX century is also presented. The role of Marshal J6zef Pitsudski in this development is pointed out. The comparison of the medical indications and contraindications in Druskininkai in the middle of the XIX century and in the thirties of the XX century are presented in more detail. The scale of medical indications was wide. Druskieniki was an important health resort in pre-war Poland.

[Anicety Renier (1804-1877) and his significance for development of Druskienkai]. / Anicety Renier (1804-1877) i jego znaczenie dla rozwoju Druskienik.

The aim of his paper is to present the silhouette of Anicety Renier (1804-1877), an eminent physician, patriot, deportee. His professional achievements as a physician of health resort in Druskienkai are presented widely. He was the author of publications on this health resort.

[Jan Pilecki (1821-1878) and achievements his Druskieninkai]. / Jan Pilecki (1821-1878) i jego Druskienickie osiagniecia.

The history of development of health resort Druskieniki basing on Adam Wrzosek, an eminent Polish historian of medicine pointed out. The beauty and advantages of this health resort is depicted widely. The living and professional achievements of Jan Pilecki (1821-1878), an eminent physician of health resort, his significance for development and of Druskieninkai are presented in more detail. The medical indications and contraindications in Druskieniki basing on his own experiences have been reported. Pilecki was a author of many medical publications in Polish medical magazines. His papers contained interested medical observations and description of social life and entertainments in this health resort.

[Deontologic aspects in publications of Bronislaw Wilhelm Sawicki (1860-1931)]. / Deontologiczne aspekty publikacji Bronislawa Wilhelma Sawickiego (1860-1931).

Bronislaw Wilhelm Sawicki (1860-1931), an eminent Warsaw surgeon who received an extensive education at foreign medical institutions, was an expert in various problems of hospital management. The complicated problems of education of physicians in the Russian sector of partitioned Poland (the Grand Duchy of Warsaw and the Congress Kingdom of Poland) formulated by Sawicki are presented in this work. Medical education in Western Europe especially in Germany, Austria and France, is described in detail. The problems of hospital assistants in the second part of the 19th and in the beginning of the 20th century are discussed.

[Contribution by Ksawery Wolfgang (-1864) to the development of Druskininkai]. / Osiagniecia Ksawerego Wolfganga (-1864) w rozwoju Druskiennik.

We present the history of the spa of Druskininkai which was founded in 1837. The professional and scientific career of Ksawery Wolfgang (-1864), an eminent physician of this spa, is described in the context of his importance for the development of Druskininkai. Wolfgang was a respected person in Druskininkai. He was the editor-in-chief and publisher of the magazine "Ondyna Druskienickich Zródel" ("Ondine of Druskininkai Springs") and the author of the book "On salt springs in Druskininkai" (Vilnius 1841), as well as of several other publications. The properties of Druskininkai salt springs and their therapeutic effects in many diseases are discussed. Wolfgang was able to establish indications and contraindications to treatment in Druskininkai. Mention is made of the book "Druskininkai. A literary and medical essay" by Józef Ignacy Kraszewski and Ksawery Wolfgang (Vilnius 1848).