Clinical results evaluation of the Girdlestone's procedure after hip arthrography.

Background. To date very little work has Bern done on the clinical evaluation of the hip in patients who hale ultimately has a prosthesis removed. This operation, known in English as the Girdlestone procedure, is referred to in Poland as "pendent hip". The present authors have evaluated clinical outcomes of this procedure, taking into account its "rescue" nature.
Material and methods. 22 patients were evaluated, ranging in age from 68 to 87 years, operated in our Clinic between 1979 and 1999 (women: 62,8%; averageage of patientswhen the Girdlestone procedure was performed: 67,2 years). The average observation period after removal of the endoprosthesis was 5,2 years (ranging from 1 to 21 years). The anterolateral approach to the hip joint was used. On each occasion the wound was closed with layer sutures, leaving 4 drains. Postoperative limb traction was maintained for a period lasting form 2 to 4 weeks. The patients were allowed to walk after 4 weeks, with progressively increased load on the operated leg. Clinical evaluated of "pendent hip" was performed using the Harris scale. Shortening of the operated leg (in cm) was also included as well as successful treatment of inflammation (for a period of at least I year) with normalization of the biochemical markers of infection X-ray examinations included periarticular calcification, the remains of cement, and the degree of proximal displacement after surgery on the proximal end of the femur. The patient's subjective evaluation was also included in the overall outcome.
Results. The outcome of surgery was evaluated as good by 12 patients (54,6%), and as satisfactory by 9 (40,9%). These patients did not fully accept the shortening of the limb, the relatively small range of motion, and the need for permanent orthopedic aids (orthopedic shoes to compensate for shortening and elbow cruthes). 1 patient evaluated the outcome as poor due to persistent infection. In 95,5% of the sases the Girdlestone procedure freed the patients of infection and pain, or noticeably reduced it. Only in 1 case did it prove impossible to manage infection completely (4,5%). 18 patients had shortened limbs > 3 cm, while insufficiency of the buttock muscles with positive Trendelenburg and Duchenne signs were the cause of great difficulties and rapid fatigue during walking. The average evaluation of pendent hip using the Harris scale was 58,6 points. In radiological evaluation we often encountered the remains of bone cement. In the case of aseptic loosening this had no impact on the healing process and the late outcome of surgery. Only in I case did it prove impossible to control infection without complete removal od fragments of bone cement. Osteoporosis of the pelvis and proximal end of the femir was found in all patients.
Conclusion. The Girdlestone procedure is a sensible rescue technique both for infected hip prostheses and in situation where reimplantation of the prosthesis is technically impossible.

[Analysis of the results of peri-trochanteric fracture treated by the Ender nails]. / Analiza wyników zespolen zlaman okolokretarzowych pretami Endera.

Results of Ender nailing in 140 patients aged between 49 and 99 (mean 81 years) with peritrochanteric fracture have been analyzed. Pros and cons of the method are discussed and potential complications pointed out. The method proved useful; results were good despite advanced age of the patients. In fractures grade I and II Kayle scale Ender nailing resulted in least complications. The risk of death was doubled by delaying surgical intervention.

[Testing the osmotic-diffusion properties for the membranous dressing Bioprocess]. / Badanie wlasciwosci osmotyczno-dyfuzyjnych opatrunku membranowego Bioprocess.

In order to determine of the osmotic-diffusive properties of membranous dressing Bioprocess, which is a microfibrous network of homogeneous cellulose produced in biosynthesis by Acetobacter, the hydraulic permeability (Lp), reflection (sigma) and diffusive permeability (omega) coefficients were measured. The values of these coefficients showed that this membrane possess a low selectivity. This amount it easy permeable for solvent (water) as well as for solutions (aqueous solutions of glucose, sucrose, ethanol, NaCl or KCl). Thus, it attend a demands make for polymeric materials used in therapy of scald and ulceration.

[Gravity-osmotic pressure effect for flat polymeric membranes and three-component non-electrolyte solutions]. / Cisnieniowy efekt grawiosmotyczny dla plaskiej membrany polimerowej i trójskladnikowych roztworów nieelektrolitów.

In this paper the classification of the gravitational effects in a passive transmembrane transport is presented. Among these effects there are the flux (flux graviosmotic effect, flux gravidiffusive, current gravielectric effect) and force (pressure graviosmotic effect, pressure gravidiffusive effect, voltage gravielectric effect) gravitational effects. The pressure graviosmotic effect model equation in a single-membrane system is elaborated. In this system the flat, microporous and symmetric polymeric membrane (Nephrophan) positioned horizontally separated water and binary (aqueous glucose) or ternary (glucose-0.2 mole/l) aqueous ethanol) non-electrolyte solutions. The calculations of pressure graviosmotic effects for two (A and B) configurations of the single-membrane system were elaborated. In configuration A solution was placed in compartment below membrane and in configuration B--above membrane. These calculated results are interpreted in terms of the convective instability that increases the diffusive permeability coefficient of complex: boundary layer/membrane/boundary layer.

[Densitometric evaluation of the distal radial epiphysis in patients after Colles fracture]. / Badanie densytometryczne dalszej nasady kosci promieniowej u pacjentów po przebytym zlamaniu w miejscu typowym.

The results of bone mineral density measurements in both forearms of 50 patients aged from 51 to 83 yrs (av. 62.4) who sustained unilateral Colles fracture, were analysed. Time elapsed from fracture was from 0.5 to 6 yrs. The aim of this study was to assess the effect of previous Colles fracture on bone mineral density. It was found that after the preliminary increase of bone mineral density, there was a gradual decrease towards normal values as compared with the unbroken arm. The bone mineral density in the evaluated group with fracture was significantly lower than the control groups without fracture.

[Treatment of congenital dislocation or subluxation of the hip taken from personal material--factors determining the course and result of treatment]. / Leczenie wrodzonego zwichniecia i podwichniecia stawu biodrowego szelkami Pavlika w materiale wlasnym--czynniki wplywajace na przebieg i wynik leczenia.

A series of 65 children (130 hips) treated for congenital dislocation or subluxation of the hip with Pavlik harness been retrospectively reviewed. All patients were managed by the same physician and according to previously established principles. Mean follow-up after the termination of treatment was 7.5 months. Age at the onset of treatment and initial state of the hip were recognized as two major factors influencing the course and result of treatment. It was found, that the harness treatment is best initiated in first 9 weeks after birth and even a few weeks delay may seriously affect its efficacy. A dynamic index on alfa angle changes on serial ultrasound images of the hip (Graf method) has been introduced.

Radiological and computed tomographic studies of the width of the normal hip joint in men aged 30-60 years.

We made an attempt to evaluate the width of the joint space of the normal hip joint in men aged 30-60 years. We analysed 164 roentgenograms and 68 CT scans of the pelvis measuring the width of the right and left hip joint in four segments of the frontal plane (roentgenograms) and in three segments of the horizontal plane (CT scans). In each segment we determined the mean width of the joint space and mutual relation between the measurements by an analysis of variance and correlation coefficient. It was shown that with advancing age of the patient the joint space increased bilaterally in the inferoposterior part (segment IV on the roentgenograms and segment III on the CT scans). The width of the joint space did not change significantly with age in the remaining segments of the hip joint.

[Value of clinical examination and arthrography in diagnosis of meniscal lesions in light of arthroscopic results]. / Wartosc badania klinicznego i artrografii w diagnostyce uszkodzen lakotek w swietle wynikow artroskopii.

The results of clinical, arthrographic and arthroscopic examination in the group of 120 patients with suspected meniscal lesion have been compared. In the clinical examination the McMurray and the Apley tests revealed a good correlation with meniscal tears. Arthrography was found to be in accordance with arthroscopy in 62%. The results were falsely negative in 15% and falsely positive in 25% of patients respectively.

Chronobiological analysis of changes in circadian rhythm of anterior pituitary hormones level during glycemia normalization by means of biostator.

We compared the circadian rhythms of anterior pituitary hormones in 15 patients with noncompensated insulin-dependent diabetes on first and second day treatment with Biostator. The rhythm was evaluated by means of a least squares analysis and presented as the circle of cosinors. In noncompensated diabetes the TSH and prolactin rhythm was maintained, whereas other hormones of the anterior pituitary showed no significant rhythm. In the course of one-day normalization of glycemia by means of Biostator the TSH and prolactin rhythm was maintained, whereas the circadian rhythm of growth hormone and ACTH levels appeared with acrophase at 18.47 and 19.59 hour, respectively. The LH rhythm did not exist, whereas the FSH rhythm was dubious. One may assume that noncompensated diabetes results in the impairment of certain pituitary hormonal rhythms and these disturbances are reversible after restoring of normoglycemia.

RIA system programming by means of kinetic parameters.

Insulin-125I antibody reaction was optimized by physical-chemical parameters. After the activation energies Ea and Ed for association and dissociation, respectively were calculated from the experimental data, the theoretical values of the reaction rate constants ka and kd were determined as well as equilibrium constants K. By means of the empirical formulae, the approximate incubation time for the RIA kit and maximal percent of insulin-125I binding to antibody (%B) in relation to temperature were computed. The proposed method may be applied to the new antigen-binder systems preparation (new antibodies, shortening of the incubation time, temperature changes, influence of different ions and kind of buffer).

Control of the RIA method as viewed from the standpoint of the investigation on the kinetics of the insulin-125 I-antibody reaction.

In this paper attempts were made towards the optimalization and the control of some parameters of the RIA reaction. Basing on the law mass action, as well as on the Scatchard's and Sip's equations, the equilibrium constants for the reversible reaction: insulin-125I-antibody for different incubation temperatures were calculated. Moreover a characteristic of the antiinsulin antibody by means of the "alpha"heterogeneity coefficient was done, as well as the values of the thermodynamic function increments were calculated, which made possible to point out explicitly the optimal shape of the standard curve.