[Arthroscopic Subtalar Distraction Arthrodesis in Post-Traumatic Indications]. / Artroskopická subtalární distrakcní artrodéza v poúrazových indikacích.

PURPOSE OF THE STUDY: This manuscript aims to present the method of arthroscopic assisted subtalar arthrodesis and to evaluate the benefi ts of this surgery on our study population. MATERIAL AND METHODS: In the period from 9/2007 to 1/2020, a total of 33 subtalar arthrodesis were performed in 31 patients aged 19-66 years (mean 48 years, median 50 years). The indication for arthrodesis was subtalar arthritis causing pain and gait disorders, or hindfoot deformities (most commonly after a calcaneus bone fracture). The arthroscopic assisted subtalar arthrodesis was performed with autologous tricortical bone block graft harvesting from the pelvis, supplemented by autologous cancellous bone graft. Stabilization was achieved by cannulated screws inserted in neutral ankle position. Patients in our retrospective study were followed up for a mean of 48 months (range, 24-130 months). The patients were evaluated preoperatively and at 2 years after surgery. The hindfoot angles and height (TCA - talocalcaneal angle, CIA - calcaneal inclination angle, TCH - talocalcaneal height) were evaluated on radiographs, bone union was assessed on radiographs and CT scans. The clinical assessment was performed using the ankle-hindfoot scale (AHS) of AOFAS (AOFAS score). RESULTS: The preoperative AOFAS score was 35-68 points (mean 52, median 54), the postoperative AOFAS score at 2 years after arthrodesis was 58-94 points (mean 82, median 82). Both the mean and median values of AOFAS score showed a signifi - cant progress from the poor result to the good and excellent result. After 2 years the TCA value decreased in 18 patients (56%) by no more than 3°. The CIA decrease observed in 21 patients (64%) was by 1° on average. The TCH decrease of 1-5 mm after 2 years since the surgery was seen in 16 patients. In 2 patients incomplete healing of arthrodesis was observed, manifested as a clinically asymptomatic non-union. No deep infection was reported. DISCUSSION: In agreement with the current literature, the arthroscopic subtalar arthrodesis has been confi rmed to be a safe method for the management of consequences of hindfoot fractures, with minimum complications and leading to accelerated bone fusion. Differences can be found in the approach, position, use of cancellous bone graft and surgical techniques. In recent years, prone position, posterior approaches, use of cancellous bone graft, distraction and fi xation with 2-3 screws divergently inserted into the bone prevail. The degree of healing of the bone fusion is generally an important factor. In our study population, non-healing was recorded in 2 patients, namely in the form of a clinically silent non-union. Neurological or early complications and/or osteosynthesis material failure occurred in up to a maximum of 10% of cases. The conclusive results of minimally invasive arthrodesis based on the AOFAS score have been confi rmed by us as well as by most authors. CONCLUSSIONS: Our study confi rmed that the arthroscopic assisted subtalar arthrodesis is a successful, reliable and safe minimally invasive method, with minimum complications, leading to stable arthrodesis. KEY WORDS: subtalar arthrodesis, subtalar arthroscopy.

Synthetic Lethality - Its Current Application and Potential in Oncological Treatment.

BACKGROUND: Synthetic lethality is a gene interaction where a defect in one of the interacting genes is compatible with cell viability, whereas the disruption of both genes leads to cell death. The discovery of the lethal effect of poly(ADP-ribose) polymerase (PARP) inhibitors in BRCA1/2 mutant cells has opened an important direction in the development of targeted therapy in oncology. The PARP inhibitor olaparib has become the first registered drug for recurrent high-grade serous ovarian cancer treatment based on synthetic lethality that has reached the clinic. Current research focuses on the combination of PARP inhibitors and inhibitors of kinases, which control the cell cycle, to prevent or overcome resistance to PARP inhibitors. There are also ongoing clinical trials which examine PARP inhibitor treatment in other types of cancers including tumours presenting the so-called BRCAness phenotype. Screenings for new synthetic lethalities which could serve as potential targets for new drug development have improved with the CRISPR/Cas9 technology, but another key problem persists in the screening efforts, namely the incomplete penetrance of synthetic lethality throughout a tumour cell population. PURPOSE: This paper summarises the current application of synthetic lethality principles in oncology and discusses the challenges in research focused on potential new drugs based on synthetic lethality.

[Vascularization of the lateral heel in relation to extensive skin incisions in osteosynthesis of calcaneal fractures]. / Vaskularizace laterální strany paty ve vztahu k extenzivnímu koznímu rezu k osteosyntéze zlomeniny kalkanea.

The aim of the study was to document soft tissue vascularization of the lateral heel on cadavers and, therefore, to indirectly demonstrate the importance to perform perfectly precise incisions, in order to prevent ischemic complications. Sections of 8 human lower limb cadavers were performed in cooperation with the Anatomical Institute of the MU Medical Faculty in Brno, according to current common standards for anatomical preparations. In successive steps, cutaneous and subcutanous covers of the lateral ankle, malleolar and heel regions were preparated. Final branches of the individual arteries were followed and the authors aimed to demonstrate their vascular arcade consisting of anastomosis of the lateral calcaneal artery--LCA (a branch of a. peronea)--which is a clinical term for rami calcaneares laterales, ventrolateral tarsal arteries--LTA (a branch of a. dorsalis pedis) and lateral malleolar artery branching off medially--LMA (a branch of a. tibialis ant.). The course of the arteries and their location is related to a reference point--a lateral tip of the lateral ankle. The investigators found out that all three arteries, as well as the arterial arch, had standard courses. The course of the arch defines the outline of the lateral extensive incision during osteosynthesis in calcaneal fractures, which lies fairly close to the lateral outline of this vascular arcade. Incorrect performance of the incision results, invitably, in serious ischemic complications. Open reduction and internal fixation of intraarticular calcaneal fractures has become a standard surgical method. Correct indication, good timing and saving open reduction, internal fixation using arthroscopy and early mobilization are the prerequisites to prevent further postoperative complications and to achieve complete healing of the fracture. Considering the demandingness of these fractures treatment and their rare incidence, their management should be centred in specialized traumatological clinics.

[Results of the elective laparoscopic appendectomy in unexplained pains in the right hypogastrium]. / Výsledky elektivní laparoskopické apendektomie u nejasných bolestí v pravém hypogastriu.

AIM: The aim of this study is to assess results of surgical therapy in female patients with clinical diagnoses of unexplained pains in the right hypogastrium. STUDY GROUP: The study was conducted with a group of female patients, who were indicated for elective laparoscopic appendectomy. All girls underwent complete laboratory and clinical examinations prior to the procedure, and, later, histological findings and peroperative findings were added. The patient group was then re-examined retrospectively. All procedures were conducted at the Clinic of Paediatric Surgery, Orthopaedics and Traumatology in Brno. METHODOLOGY: A follow-up examination of clinical symptoms was the primary method in the study. After 3 years of the procedure, the girls were asked to fill in a questionnaire, including 5 questions with pre-defined answers. Complete records of 67 female patients were obtained during the period 1997-2000. RESULTS AND CONCLUSION: Over 80% of the enquired female patients experienced no further symptoms. The study confirmed positive effects of elective appendectomies in unexplained pains in the right hypogastrium.

[Surgical treatment method of calcaneal intraarticular fractures]. / Operacní metoda lécby nitrokloubních zlomenin patní kosti.

Open repositioning and internal fixation of intraarticular calcaneal fractures has become a standard surgical method, however, concerns over its feared complications, including, in particular, secondary wound healing followed by osteomyelitis, continue fo be discussed. The aim of this study is to inform the surgical public about the surgical method. From February 2004 to September 2005, 26 intraarticular calcaneal fractures in 22 patients were operated using open repositioning and internal cast fixation. In four cases, the fracture was bilateral. The patients were indicated for the procedure based on the Sanders CT classification. The procedure included extensive L-shaped lateral approach (Seattle), anaemization, minimization of soft tissue disruption, and was followed by spongioplasty. In isolated dislocated sustentacular fractures, osteosynthesis through a medial approach was completed, using screws. Post-operatively, the extremity was not fixated and early rehabilitation was initiated. In majority of the operated patients, the skin cover healed per primam. In 3 patients, the wound healed per secundam intentionem. Complete fracture healing was x-ray confirmed in all patients. No signs of the osteosynthetic material release or of pronounced signs of subtalar arthrosis or of a foot arch collapse were present. No deep defects or other serious postoperative complications were recorded. The follow-up period lasted for 6-22 months and goes on. The patients followed for over a year period have no symptoms, they fully wightbear the operated extremity and they have returned to their original professions. Open repositioning and internal stable cast fixation is recommended as a standard treatment method in these fractures.

[The effect of overloading from intensive maneuvering on the function of the peripheral chromatic field of vision]. / Vliianie peregruzok intensivnogo manevrirovaniia na sostoianie perifericheskogo khromaticheskogo polia zreniia.

Data on the peripheral chromatic field of vision (PCFV) in pilots after centrifugation and missions with intensive maneuvering associated with accelerations (+Gz) higher than 6 g are presented. Depression of the PCFV area due to hypergravity was most expressed in the shortwave section of the visible spectrum and closely linked with the state of cranial hemodynamics. Changes in PCFV persisted for quite long period, i.e. initial values did not regain following 40 min since exposure to accelerations. Correlation between the degree of PCFV changes and pilot's tolerance to accelerations was established. According to the factual data analysis, the PCFV technique can be used to evaluate the dynamics of G-tolerance during intensive maneuvering aircraft.