[Assessment of Clinical Outcomes of Surgically Treated Rockwood Type III Acromioclavicular Dislocation with or without Coracoclavicular Ligament Suture]. / Zhodnocení klinických výsledku operacne resených akromioklavikulárních luxací typu Rockwood III se suturou ci bez sutury korakoklavikulárního vazu.

PURPOSE OF THE STUDY Acromioclavicular (AC) joint dislocation and its surgical treatment still raises a number of questions that remain to be answered. In some types of dislocations, Rockwood type III in particular, the indication for surgical treatment as such is relative. There are numerous techniques and implants available for the reconstruction of AC joint. In our research we focused on the necessity of coracoclavicular (CC) joint reconstruction. MATERIAL AND METHODS In this paper, a cohort of 56 patients with Rockwood type III AC joint injury who underwent surgical treatment at our department in 2010-2016 period was retrospectively evaluated. The patients were treated with open reduction with AC joint stabilisation using hook plate or tension band. The patients were divided into 2 groups, namely group 1 with CC ligament reconstruction and group 2 without CC ligament reconstruction. The assessment was done at 6 months, 1 year and 2 years after surgery. The clinical outcomes were assessed based on the absolute Constant score (CS) and coracoclavicular distance (CCD) on the X-ray. Subsequently, the outcomes were statistically processed and compared using the Student s ttest. RESULTS The least invasive surgical intervention, as to the length of incision, was the reconstruction using the hook plate without CC ligament suture, whereas the longest incision was performed in tension band with CC ligament suture. In the CC ligament suture group, the mean operative time was 10 minutes longer. When evaluating the CS of the compared groups with and without CC ligament reconstruction, no statistically significant difference (p > 0.05) was found between the two groups. Similarly, the CCD values at 2-year follow-up did not show any statistically significant difference between the two groups (p > 0.05). CONCLUSIONS The available outcomes suggest that the surgical methods used by us are adequately safe and reliable. Good clinical outcomes can be achieved by open reduction and fixation of Rockwood type III AC joint dislocation even without CC ligament reconstruction. Key words: acromioclavicular dislocation, classification, reconstruction, coracoclavicular ligament.

Treatment of Large Cartilage Defects in the Knee by Hydrogel-Based Autologous Chondrocyte Implantation: Two-Year Results of a Prospective, Multicenter, Single-Arm Phase III Trial.

OBJECTIVE: To evaluate the clinical outcome of a hydrogel-based autologous chondrocyte implantation (ACI) for large articular cartilage defects in the knee joint. DESIGN: Prospective, multicenter, single-arm, phase III clinical trial. ACI was performed in 100 patients with focal full-thickness cartilage defects ranging from 4 to 12 cm2 in size. The primary outcome measure was the responder rate at 2 years using the Knee Injury and Osteoarthritis Outcome Score (KOOS). RESULTS: Two years after ACI treatment, 93% of patients were KOOS responders having improved by ≥10 points compared with their pre-operative level. The primary endpoint of the study was met and demonstrated that the KOOS response rate is markedly greater than 40% with a lower 95% CI (confidence interval) of 86.1, more than twice the pre-specified no-effect level. KOOS improvement (least squares mean) was 42.0 ± 1.8 points (95% CI between 38.4 and 45.7). Mean changes from baseline were significant in the overall KOOS and in all 5 KOOS subscores from Month 3 (first measurement) to Month 24 (inclusive) (P < 0.0001). The mean MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score after 24 months reached 80.0 points (95% CI: 70.0-90.0 points) and 92.1 points in lesions ≤ 5 cm2. CONCLUSIONS: Overall, hydrogel-based ACI proved to be a valuable treatment option for patients with large cartilage defects in the knee as demonstrated by early, statistically significant, and clinically meaningful improvement up to 2 years follow-up. Parallel to the clinical improvements, MRI analyses suggested increasing maturation, re-organization, and integration of the repair tissue. TRIAL REGISTRATION: NCT03319797; EudraCT No.: 2016-002817-22.

[Revision ACL Reconstruction in Our Study Population]. / Reoperace plastik LCA v nasem souboru.

INTRODUCTION The authors present the long-term clinical outcomes of revision anterior cruciate ligament (ACL) reconstruction. The aim was to compare the surgical technique with respect to the clinical outcomes within 3 years postoperatively. MATERIAL AND METHODS The clinical evaluation of revision anterior cruciate ligament reconstructions performed at our department in 2002-2017 was carried out. A total of 82 patients were included in the study, male as well as female patients. Apart from the clinical outcomes, the associated procedures performed as a consequence of other injuries or damage to other intraarticular structures, the surgical technique as such, potential complications of revision reconstruction and causes of failure were studied. The same criteria were followed up in all the patients - clinical range of motion (ROM) of the operated knee, knee stability - pivot shift test, instrumental Lachman test using Rolimeter, IKDC subjective form, Tegner and Lysholm scores. RESULTS In the group of patients, the surgical technique involved the use of a harmstring tendon autograft as a new graft for revision in 43 patients, a BTB autograft in 25 patients, and a BTB cadaverous graft in 14 patients. In 24 cases, a two-stage surgery was performed. The interval between the first- and the second-stage procedure ranged from 6 weeks up to 6 months, with the median of 62.4 days. During the evaluation, no difference was observed whether one-stage or two-stage surgery was performed, therefore this is not reflected in the overall evaluation. The clinical evaluation resulted in the following mean values when comparing the preoperative and final postoperative findings: The mean value of the IKDC subjective knee form score was 42 (30-62) preoperatively and increased to 77 (66-89) at 3 months. The values obtained at 6 months, 1 year and 3 years were 84 (73-93), 88 (79-100) and 89 (78-100), respectively. The mean value of the Lysholm score in the followedup study population was 63 preoperatively, which indicates a clearly poor result. The score rose to 71 (62-88) at 3 months, to 79 (67-92) at 6 months, to 89 (67-94) at 1 year, and at 3 years the mean score was again 89 (66-95). No serious complications were reported. CONCLUSIONS The results confirmed sufficient postoperative stability of the knee joint. In terms of function and pain perception the treatment was considered appropriate. No major complications occurred during surgeries. Based on the results, the authors foresee the patient s return to sports, at least at recreational level. Key words: anterior cruciate ligament, reconstruction, revision reconstruction, knee arthroscopy, instrumentarium.

[Unexpected Finding of a Foreign Body in the Knee Joint Area of a 10-Year-Old Boy]. / Neocekávaný nález cizího telesa v oblasti kolenního kloubu desetiletého chlapce.

Differential diagnosis of tumor processes in orthopedics is a relatively broad and inherently very serious issue, especially if the patients are pediatric patients. A number of examination procedures is used in diagnostics, together with a wide range of complementary laboratory and imaging methods. However, the clinical examination, including the collected anamnestic data, remains to be the cornerstone. In pediatric patients, of major importance is the cooperation with parents, but not always necessary information is provided to make the final diagnosis. In younger children, it is very often impossible to obtain relevant anamnestic data due to a number of factors that are typical for pediatric patients, namely fear, noncooperation, misunderstanding of questions, mainly as a result of mental immaturity. Therefore, diagnosis in these cases is based primarily on clinical and complementary findings. This work presents a complex issue of this diagnosis, with a surprising and unexpected finding of a foreign body in the knee joint of a pediatric patient, which completely changed the subsequent treatment strategy. It concerned a 10-year-old boy referred to our clinic from another workplace for suspected tumor process in the knee joint. The whole process of examination and final diagnosis depends on a number of detailed information that we have tried to obtain throughout the process. Key words: tumor, knee, foreign body, diagnostics, imaging methods.

[Rare Vascular Complication after ACL Reconstruction]. / Vzácná cévní komplikace po náhrade predního zkrízeného vazu.

The anterior cruciate ligament reconstruction is currently one of the most commonly performed arthroscopic procedures of knee joint. Overall, it is a reliable and sophisticated procedure associated with a relatively low complication rate. In the available literature, less severe complications are reported in 3-7% of cases. The most frequent complications are intractable pain not manageable using analgesic therapy (6.7%), hemarthrosis requiring puncture (4.4%), fever (3.2%) and other complications related in particular to immobilisation (1.2%). The percentage of severe complications is very low (less than 1%). These include deep vein thrombosis (0.6%), cellulitis (0.6%) and infectious complications requiring arthroscopic or surgical revision (0.3%). Vascular injuries around the knee joint are rare and are described in case studies only. The authors present a patient with reduced mobility of the knee and significant pain, haematoma and swelling in the calf, which developed within a short time span after the reconstruction of anterior cruciate ligament. It was caused by bleeding into the medial gastrocnemius muscle. This rare vascular complication was diagnosed angiographically and coiling was used to stop the arterial bleeding, once deep vein thrombosis, congenital haemostasis, gonitis and compartment syndrome were excluded. Key words: ACL reconstruction, angiography, anterior cruciate ligament, arthroscopy, inferior medial genicular artery, vascular complications.

Surgical treatment of fractures of the distal radius - ORIF vs external fixation with ligamentotaxis.

INTRODUCTION: The study compares the results of open reduction using volar locking plates with ligamentotaxis by external fixation in fractures of distal radius type 2R3C according to AO classification. METHODS: A retrospective study evaluating the results of osteosynthesis in patients with distal radius fractures type 2R3C according to AO classification, operated until December 2018. The ORIF method with volar locking plates (LCP) was used in 54 patients, and closed reduction with ligamentotaxis using external fixation (EF) was used in 33 patients. The mean age of the patients was 46.7 years in the LCP group and 59.6 years in the EF group. All were evaluated for their X-ray and functional outcomes and according to the Green and OBrien score at 6 and 12 months after surgery.  Results: According to X-rays at 12 months in the LCP group, the mean sagittal tilt was 10.13°, the mean radial inclination was 23.89°, and the mean radial length was 11.84 mm. In the EF group, the mean sagittal tilt was 6.32°, the mean radial inclination was 24.78°, and the mean radial length was 9.89 mm. According to the Green and OBrien score, we recorded a mean score of 84.44 points in the LCP group at 12 month; we achieved good and excellent results in 83.33% of the patients and no poor result was observed. In the EF group the final mean score was 77.27; good and excellent results were achieved in 45.46% of the patients and a poor result in one patient. CONCLUSION: Based on the results in our group of patients, the internal type osteosynthesis using LCP implants can be recommended as a first-choice technique in the treatment of 2R3C fractures according to AO classification.

[Our Experience with RM Pressfit Vitamys Cup and Cementless Optimys Short Stem]. / Nase zkusenosti s jamkou RM Pressfit Vitamys a s krátkým necementovaným dríkem Optimys.

INTRODUCTION The purpose of our study was to evaluate the clinical outcomes in patients at 3-6 years follow-up after primary implantation of RM Pressfit Vitamys cementless elastic cup and cementless Optimys short stem, including bone tissue remodelling around both the components. MATERIAL AND METHODS The evaluation covered 49 joint replacements in patients who had undergone surgery at our department between 2012 and 2015. The age at the time of primary surgery ranged from 29 to 71 years, with the mean value of 59.2 years. Postoperatively, the position of endoprosthesis, changes in femoroacetabular offset, signs of osseointegration of the implant, bone tissue remodelling around both the components and potential signs of aseptic loosening were assessed. The functional status of the joint was evaluated according to the Harris scale. RESULTS The mean follow-up time of Vitamys cup and Optimys stem was 5.6 years and 4.6 years, respectively. We focused on the combination of RM Pressfit Vitamys (49x), Optimys (28x) and Bionit 2 (41x) implants. All the cups showed good osseointegration. Based on the comparisons with a postoperative X-ray, at least mild osteoporosis in the acetabular roof was confirmed in 6 cases. All Optimys femoral components were in direct contact with the Adams arch and with the endosteal side of lateral cortex of proximal femoral metadiaphysis. Femoroacetabular offset was slightly decreased in 5 patients only. The final evaluation in 2018 did not confirm any radiolucent lines or signs osteolysis around any of the components. In 2 stems only, distal migration less than 2 mm was obvious, with subsequent good osseointegration. Signs of stress shielding were present in 2 femoral components in the form of mild cortical atrophy in the region of the Adams arch. Distal femoral cortical hypertrophy was not observed, the greater trochanter did not show the loss of bone tissue in any of the patients. There were no signs of polyethylene wear. The mean value of HHS increased from 53 to 97 points. An excellent result was achieved in 44 total hip replacements, of which 100 points in 28 cases. In the remaining 5 patients the result was good. The survival rate of both the components was 100% according to the Kaplan-Meier analysis. DISCUSSION The successful functioning of cementless total hip arthroplasty is the correct placement of both components with good primary fixation. Excessive proximal and lateral shift of the centre of rotation results in increased load of endoprosthesis and risk of earlier aseptic loosening, its reduction leads to the weakening of pelvitrochanteric muscles. The shift of the centre of rotation from the original anatomical position should therefore not exceed 5 millimetres. Insufficient cup fixation always results in mechanical failure of an endoprosthesis. Distal migration of stems without contact with external femoral cortex with full weight-bearing of the operated lower extremity in the postoperative period does not constitute a sign of instability, but only its placement enables good osseointegration. Bone remodelling can be assessed by imaging techniques at 2 years after the primary implantation at the earliest. At places with lower load, the bone loss occurs and the loss of bone trabeculae can lead to the failure of fixation of the component. At places with load accumulation, the bone hypertrophy occurs that can be manifested by thigh pain. In case of cementless press-fit cup, the degree of bone remodelling depends on its elasticity, in case of stem on the used material, shape and fixation site. CONCLUSIONS The RM Pressfit Vitamys monobloc cup through its mechanical properties approximates the best the elasticity of bone tissue. The stress distribution around the implant is more symmetrical as against other conventional cementless cups. The Optimys stem enables the reconstruction of anatomical conditions corresponding a healthy hip joint. Respecting the rule of at least three-point fixation is a precondition for good and fast secondary stability of components. Minimising the wear of articulating surfaces and physiological remodelling of adjacent bone tissue are the main factors that help prolong the survivorship of both the components, while also securing more favourable conditions and better outcomes in case of necessity of reimplantation. Key words: cementless elastic cup, short cementless stem, femoroacetabular offset, stress shielding, osseointegration of the implant.

Performance comparison of Yb:YAG ceramics and crystal gain material in a large-area, high-energy, high average-power diode-pumped laser.

We compare for the first time the influence of different Yb:YAG gain media on the performance of a large-area, high average-power laser system with an output energy of up to 6 J. Monocrystalline slabs grown by a new technique without central growth defect are compared with ceramics. Small signal gain, maximum output energy and thermal lensing are compared for ceramic slabs with co-sintered amplified spontaneous emission (ASE) absorber cladding, monocrystalline slab with and without optically bonded ASE absorber cladding, and surface structured monocrystalline slabs. We show that these large monocrystals with optically bonded absorber cladding have similar performance to cladded ceramics, so far the only material for high-energy Yb:YAG lasers.

[Rare Vascular Complication after ACL Reconstruction]. / Vzácná cévní komplikace po náhrade predního zkrízeného vazu.

The anterior cruciate ligament reconstruction is currently one of the most commonly performed arthroscopic procedures of knee joint. Overall, it is a reliable and sophisticated procedure associated with a relatively low complication rate. In the available literature, less severe complications are reported in 3-7% of cases. The most frequent complications are intractable pain not manageable using analgesic therapy (6.7%), hemarthrosis requiring puncture (4.4%), fever (3.2%) and other complications related in particular to immobilisation (1.2%). The percentage of severe complications is very low (less than 1%). These include deep vein thrombosis (0.6%), cellulitis (0.6%) and infectious complications requiring arthroscopic or surgical revision (0.3%). Vascular injuries around the knee joint are rare and are described in case studies only. The authors present a patient with reduced mobility of the knee and significant pain, haematoma and swelling in the calf, which developed within a short time span after the reconstruction of anterior cruciate ligament. It was caused by bleeding into the medial gastrocnemius muscle. This rare vascular complication was diagnosed angiographically and coiling was used to stop the arterial bleeding, once deep vein thrombosis, congenital haemostasis, gonitis and compartment syndrome were excluded. Key words: ACL reconstruction, angiography, anterior cruciate ligament, arthroscopy, inferior medial genicular artery, vascular complications.

[New Anterior Cruciate Ligament Reconstrucion Using Harmstring Tendon Grafts - Clinical Part]. / Nová metoda rekonstrukce predního zkrízeného vazu kolenního kloubu pomocí hamstringu ­ klinická cást.

PURPOSE OF THE STUDY The authors present the clinical use of the new instrumentation set for the anterior cruciate ligament (ACL) reconstruction using the hamstring tendons (HS). The positionning of the femoral tunnel and the fixation of the graft play an important role for the results of the surgery. The aim of the study was to confirm the proposed surgical technique and the methods of the graft fixation, especially from the point of view of the clinical midterm results at the evaluation up to eight years after the surgery. MATERIAL AND METHODS The clinical evaluation comprises 58 patients operated from 2007 to 2014 using the new instrumentation set. There were 9 men and 49 women included in the sample. The mean age was 34.6 years (range 18 - 58 yrs), namely 36.7 in women and 32.4 years in men. The evaluation was performed pre-opeatively and at 3 and 6 months, 1, 3, 5 and 8 years post-operatively. All the patients were followed based on the same criteria - clinical range of motion (ROM), stability of the knee - instrumentation Lachman test utilizing Rolimeter, subjective IKDC score and pain VAS scale for the harvesting site. The ocurrence and the rate of post-operative complications were monitored. RESULTS The integration and the ingrowth of the graft were achieved in all cases, the full ROM was gained as well, no pathological instability was observed. The fixation of the HS graft in the bone was confirmed by post-op X ray at 3 months after the surgery. The clinical evaluation showed the following mean differences in the pre-op and final post-op findings. The average preoperative laxity using the Lachmann test was 9.7 mm (range 6-12 mm), at 3 months 1.8 mm (1.4-2.1 mm), at 6 months 1.6 mm (1.2 - 2.2 mm), at 1 year 1.6 mm (1.1-2.3 mm), at 3 years the stability was 1.7 mm (1.2 mm-2.4 mm), at 5 years 2.3 mm (1.2-3.6 mm) and at 8 years after surgery it was 2.5 mm (1.2-3.9 mm). None of the patitents included in the study showed pathological instability that would be considered an indication for revision. In the evaluation of the subjective IKDC score, the pre-operative average was 56, with the range of 42-66, at 3 months post-operatively 79 (69-85), at 6 months 88 (74-92), at 1 year 95 (88-100), at 3 years 96 (89-100), at 5 years 94 (87-100), and at 8 years 92 (84-98). No severe complications were observed. CONCLUSIONS The method provided sufficient post-operative stability of the knee joint. Fixation of the femoral screw satisfied the demands laid on it. Regarding the pain perception, the method was considered positive, the level of pain involved in the procedure was low. No severe complications or technical mistakes occurred during the surgical procedures. The new instrumentation set developed for the ACL reconstruction offers an easy technique and comfortof use. Key words:anterior cruciate ligament, reconstruction, hamstrings, knee arthroscopy, instrumentation set.

[New Technique of Anterior Cruciate Ligament Reconstruction Using Hamstrings - the Surgical Instrumentation Set]. / Nová metoda rekonstrukce predního zkrízeného vazu kolenního kloubu pomocí hamstringu ­ operacní instrumentárium.

PURPOSE OF THE STUDY The success rate of the anterior cruciate ligament (ACL) reconstruction depends on the fixation of the graft, the surgical technique and, of course, on the experience of the operating surgeon. The authors present the development of the construction of the new instrumentation set designed to manage the ACL lesions using the hamstring (HS) tendons. The study is divided into two parts, of which part one focuses on construction, methods and work with new instruments, while part two presents the outcomes of the surgery. MATERIAL AND METHODS Fixation of hamstring grafts depends, contrary to the union of bone blocks in the Bone-Tendon-Bone (BTB) graft and the bone tunnel, on the method of tendon graft fixation and compression inside the bone tunnel. The instrumentation set for ACL reconstruction is designed to be used for hamstring tendons (semitendon and gracilis) forming four strands of the prepared graft. The system was designed as the fixation of the graft using the femoral screw with eyelet and a press-fit fixation using a metal interference screw in tibia. The easiest and fastest option has proven to be the pulling of the screw with eyelet through the tibial tunnel and intra-articular space to the femoral canal, where fixation by screwing in is done. The exact position of the inserted screw is verified by the measuring gauge. The screw is pulled in by the long version of the femoral screwdriver and Kirschner wire passing through the middle of the screw with eyelet. The advantage of this system consists in the subsequent insertion of the interference screw by the same wire, which guarantees its exact positioning in the centre between the individual strands of the graft (thanks to the specific way of ligament preparation). The possibility of later tensioning of the graft by tightening the femoral screw is another advantage. DISCUSSION Compared to other methods using the HS tendons, the advantages of the described operative technique consist in the simplicity of the used instrumentation procedure. The technique of graft fixation inside the femoral canal is not suitable for bioabsorbable materials. It is offset by the fixation stability and the possibility of final graft tensioning. CONCLUSIONS The newly developed instrumentation set for ACL reconstruction is fit for purpose, easy as to the surgical technique, and it guarantees the logical sequence of surgical steps reducing surgical errors to minimum. The instrumentation set is userfriendly, easy to handle and, once the operating surgeon masters the surgical procedure, it allows to reduce the duration of the surgery to approximately 30 minutes. There were no major complications or technical errors reported during the surgical procedures using these instrumentation set. Key words: anterior cruciate ligament - reconstruction - instrumentation set - knee arthroscopy.

[Prostate carcinoma. Current dilemma of urooncology. How to help the needed and not to harm the others]. / Karcinom prostaty, aktuální dilema uroonkologie. Jak prospet ohrozeným pacientum a neuskodit tem ostatním.

There is a remarkably rising incidence of histologically proven prostate cancer since the introduction of prostatic specific antigen (PSA) test into clinical practice. TNM classification of these tumors in about 50% of cases is in categories T1,2 N0M0, Gleason score 7 and PSA level under 10 ug/ l (Graph 1). Such tumors are considered low risk and therefore conservative approach seems to be acceptable therapeutic variant. In spite of nonsurgical approach, patients with the so called early stage diagnosed disease have been almost only indicated for radical prostatectomy with a therapeutic approach. More than 2,100 men underwent radical prostatectomy (RP) in the Czech Republic in 2009 but mortality curve remained unchanged for years (Graph 2). The largest study (ERSPC) looking for influence of PSA screening on mortality, involving 182,000 men, of which 162,000 were valuable for analysis, really lowered mortality. After 11 years, in the screened arm (PCA arm) mortality decreased by more than 20% in the screened arm (PCA arm) when compared with unscreened arm. But to save one life, 1,410 patients had to be screened and 48 of them underwent RP. But ERSPC results (and those similar from eg. PLCO study) gave a rise of speculation if all early detected tumors are indeed candidates for surgery (overtreatment), even if such intensive PSA screening is reasonable (overdiagnosis). In last decades, results of several studies support an opinion that low risk tumors diagnosed in men over 68 years, with several co morbidities and in less favorite health status would not be proper candidates for conservative approach (active surveillance or watchful waiting). As a consequence of these considerations, a question arises whether selected PSA test should not be more reasonable. In such a case, a patient should thoroughly discuss what profit the PSA test brings to him with his doctor.

Finasteride treatment and neuroactive steroid formation.

Finasteride is the 5alpha-reductase inhibitor that received clinical approval for the treatment of human benign prostate hyperplasia and androgenetic alopecia. The 5alpha-reductase is enzyme responsible for the reduction of testosterone to dihydrostestosterone, progesterone to dihydroprogesterone and deoxycorticosterone to dihydrodeoxycorticosterone, steroids modulating the action of gamma-aminobutyric acid on GABA receptors. These neuroactive steroids possess anticonvulsant, antidepressant and anxiolytic effects. The objective of the study was to determine the effect of finasteride therapy on a broad steroid spectrum in men with benign prostate hyperplasia. A group of 20 men with benign prostate hyperplasia was involved in the present study. Finasteride in the daily dose of 5 mg/day was administrated for 4 months. In all individuals, their hormonal profile of steroid hormones was determined before and after 4 months lasting finasteride treatment. Finasteride treatment resulted in a significant decrease all alpha-reduced and increase of most 5beta-reduced metabolites of testosterone and progesterone as well as in an increase of 7alpha-hydoxyderivatives, which are known as neuroactive steroids acting by modulation of GABAA and NMAD receptors in the brain. In the course of finasteride treatment the decrease of the concentration of circulating steroids with known inhibitory activity on GABA-ergic excitation in the brain is very probably an important factors contributing to the development of the symptoms of depression seen in some isolated cases of finasteride administration.

[Method of functional treatment of distal radius fractures]. / Vyuzití funkcní lécby v terapii zlomenin distálního radia.

PURPOSE OF THE STUDY To present the method of functional treatment of distal radius fractures, and to evaluate its results in a group of 57 patients. MATERIAL The method described here was used to treat a Colles fracture in 57 patients between 2001 and 2005. The average age of patients at the time of injury was 62 years (range, 19 to 82). The minimal interval between the end of treatment and the evaluation of the patient group was one year. METHODS The presented method is based on the principles of functional treatment of wrist fractures, as advocated by Sarmiento et al. When the patient has been indicated for this treatment, the arm is immobilised in a classic rigid cast. This cast is changed three weeks after application for a cast permitting full palmar flexion and full ulnar deviation. The cast is removed when callus formation is detected and the fracture site is free of pain. During this treatment, much attention is paid to skin condition, with an emphasis on preventing the development of Sudecks algoneurodystrophy. RESULTS This method of functional treatment resulted in complete fracture healing in all patients. None of them required hospitalization. The total period of immobilization was on average 45 days, ranging from 41 to 57 days. On subjective evaluation the patients regarded both the course and the result of treatment as good. DISCUSSION In this paper the authors address the permanent conflict between concepts of surgical and conservative therapy. Their results fully support the fact that the freedom of motion of all joints for a greater part of treatment is necessary for healing as well as prevention of a subsequent restriction of the range of motion. They also provide evidence that this modified method facilitates healing without complications. The patients were satisfied with the outcome of treatment; there was no poor result reported. CONCLUSIONS The method of functional treatment for distal radius fractures is an effective procedure allowing for good bone healing with a minimum of complications. In addition, the treatment can almost exclusively be carried out in an out-patient department. The mechanism promoting the process of osteogenesis in its course is not known yet. However, it has to be mentioned that the method is time-consuming for both the physician and the patient. Key words: distal radius fracture, functional treatment, Sarmientos method.

[Autologous chondrocyte implantation in the treatment of cartilage lesions of ankle joint]. / Transplantace kultivovaných autologních chondrocytu hlezenného kloubu.

PURPOSE OF THE STUDY: The authors present the results of surgical treatment of talar dome cartilage defects. They used the transplantation of autologous cultured chondrocytes in the form of a solid chondral graft. MATERIAL AND METHODS: Patients with chondral lesions categorized as grades II to IV by the Anderson classification or as grades II to IV by the Berndt and Harty classification were indicated for this treatment. After preoperative MRI examination, a small sample of healthy cartilage was harvested arthroscopically from the non-weight-bearing area of the talus and was sent to the Tissue Bank in Brno for chondrocyte cultivation. After 28 to 42 days the cultured chondrocytes were formed into a solid chondral graft, implanted at the damaged site of the talar dome and fixed with fibrin glue (Tissucol). RESULTS: Between July 2003 and October 2005 five patients, three males and two females, were treated using this method. Their age ranged from 22 to 46 years. Follow-up was 6 to 24 months, with an average of 12.6 months, and the patients were examined by MRI at 2 weeks, 2 and 6 months and at 1 year. The clinical results were evaluated on the basis of the Mazur and Weber scoring systems. CONCLUSIONS: A significant improvement in clinical function of the ankle joint was achieved in three patients and the condition remained unchanged in one patient. In one patient, the surgical outcome was too recent for evaluation, but the MRI results indicated tendency to good incorporation of the graft.

Hormonal homeostasis in a group of 216 aging Czech males and correlation with responses to a questionnaire of the University of St Louis.

UNLABELLED: The male aging process is accompanied by changes in the levels of several types of hormones. Falling levels of androgenic-anabolic steroids (total testosterone, free testosterone, biologically accessible testosterone, dehydroepiandrosterone) correspond to a group of symptoms referred to as PADAM syndrome (Partial Androgen Deficiency in the Aging Male). In the case of those carefully examined patients with symptoms of PADAM and proven hypogonadism, administering androgen supplements can alleviate some of the undesirable manifestations. In its literature, the University of St Louis repeatedly refers to its questionnaire as a verbal tool for the detection of possible hypogonadism. The aim of this study was to ascertain to what extent the aging process is evident in hormonal homeostasis detected in laboratory testing, and the extent to which this data is in accord with the evaluation of responses to questions in the University of St Louis questionnaire. METHOD: 216 men aged over 50 years were examined. Measurements were taken of: testosterone; the index of free testosterone; androstenedione; dihydrotestosterone; dehydroepiandrosterone and its sulfate; isomers 7alpha- and 7beta-hydroxydehydroepiandrosterone; epitestosterone; luteinizing hormone (LH); follicle-stimulating hormone (FSH); prolactin; and sexual hormone-binding globulin (SHBG). Evaluations of the patients' responses to the University of St Louis questionnaire were compared with the results of the laboratory tests. RESULTS: The study confirms that the most prominent phenomenon is that of an age-related decrease in the index of free testosterone, which is indicated in particular by an increase in the level of SHBG, and by a decrease in dehydroepiandrosterone and its derivatives. No significant correlation was found between levels of hormones and single items on the questionnaire, nor with the overall score arrived at by studying the patients' data.

[Therapy of severe chondral defects of the patella by autologous chondrocyte implantation]. / Lécba hlubokých chondrálních defektu pately transplantací kultivovaných autologních chondrocytu.

PURPOSE OF THE STUDY: The aim of this study was to present the results of treatment of deep chondral defects of the patella by transplantation of a solid chondral graft formed by autologous cultured chondrocytes. MATERIAL AND METHODS: Indications for autologous chondrocyte implantation most frequently included acute trauma to the knee, particularly the patella, which resulted in a severe focal cartilage defect. The lesions were assessed on the basis of the Bessette and Hunter classification preoperatively, and on the Outerbridge classification during arthroscopy. A sample of healthy cartilage was harvested from a non-weight-bearing area of the trochlea femoris. After cultivation of chondrocytes for 28 to 42 days in the tissue bank, a solid chondral graft, prepared with the use of fibrin glue (Tissucol), was ready for implantation. RESULTS: Six patients, two males and four females (average age, 21.1 years; range, 13 to 39 years) were treated by this method in the period from July 2003 to October 2005. Follow-up ranged from 1 to 25 months, with an average of 18.5 months. The patients were examined postoperatively by magnetic resonance imaging (MRI) at 2 weeks, 2 and 6 months, and at 1 year. The clinical results were evaluated by the Meyers, the Tegner and the Lysholm knee scoring systems. Two of the six patients, in whom the follow-up period was shorter than 6 months, were not included in the evaluation. CONCLUSIONS: A significant improvement in knee function was recorded when the preoperative and final follow-up stages were compared, as well as on comparison with the healthy contralateral knee joint. MRI examination showed good graft incorporation in all patients.

Gatifloxacin 200 mg or 400 mg once daily is as effective as ciprofloxacin 500 mg twice daily for the treatment of patients with acute pyelonephritis or complicated urinary tract infections.

The efficacy and safety of two oral dosing regimens of gatifloxacin were compared to ciprofloxacin in the treatment of complicated urinary tract infection in a randomised, double-blind multi-centre trial. One thousand one hundred and twenty-three adult patients with complicated urinary tract infection (70%) or pyelonephritis (30%) were initially enrolled, 1122 were treated. Of these, 824 were included in a modified ITT population: gatifloxacin 200 mg (274 patients) or 400 mg (280 patients) once daily or ciprofloxacin 500 mg twice daily for 5-14 days (269 patients). Bacteriological and clinical responses were assessed 7-9 days after the end of treatment (EOT) and 4-6 weeks post-treatment (end of study visit, EOS). The bacteriological response rates per patient at EOT in the gatifloxacin 400 mg, gatifloxacin 200 mg and ciprofloxacin groups were 77% (207/269), 78% (208/268) and 73% (190/259), respectively. At EOS they were slightly lower: 70% (184/262), 71% (176/248) and 69% (174/252), respectively. The clinical responses at EOT were 69% (190/277), 70% (190/273) and 65% (174/266). At EOS they were 71% (193/273), 70% (182/259) and 74% (190/258). The overall eradication rates of initial pathogens at EOT and EOS were 85.3% and 88.4% in the gatifloxacin 400 mg group; 84.1 and 90.1% in the gatifloxacin 200 mg group and 85.1 and 91.4% in the ciprofloxacin group. Both oral regimens of gatifloxacin were as effective as that of ciprofloxacin. All treatment groups showed a similar safety profile, nausea being the most frequently reported adverse event.

[Hormones and quality of life in aging men]. / Hormony a kvalita zivota stárnoucích muzu.

BACKGROUND: Aging men suffer from a decrease of androgen-anabolic steroids known as "Partial Androgen Decline in the Aging Male" (PADAM) that is sometimes compensated by the use of androgen replacement therapy. METHODS AND RESULTS: To decide whether androgen therapy should be considered, hormonal serum levels are commonly tested. In addition, the St. Louis questionnaire is used as and indication. Accordingly, serum levels of testosterone, androstendione, dihydrotestosterone, dehydroepiandrosterone, its sulphate, epimers of 7-hydroxy-dehydroepiandrosterone, epitestosterone, lutropin, follitropin, prolactin and sex hormone binding globulin were measured in 216 men over 50 years of age. Further, the Sr. Louis questionnaire was applied and the extent of the relations among the data was evaluated. RIA and IRMA kits from Immunotech and Orion-Diagnostica were used for measurement of the hormones except epitestosterone and 7-hydroxy-dehydroepiandrosterone epimers, which were determined using specific radioimmunoassays. CONCLUSIONS: The decline in the index of free testosterone, given by the increase of SHBG levels, as well as the decrease in the levels of DHEA and its derivates were the most prominent. No correlation was found between the levels of hormones and the individual items of the questionnaire or with the total score calculated from the questionnaire data. In conclusion, the University of Saint Louis questionnaire did not give a reliable indication of an androgen deficit. However, the found values and their changes can still be helpful during the decision process concerning indication and initiation of hormone replacement.

Familial prostate cancer: outcome following radiation therapy with or without adjuvant androgen ablation.

PURPOSE: To compare the outcome of familial versus sporadic prostate carcinoma after definitive external radiation. METHODS AND MATERIALS: Between 1987 and 1996, 1214 men with clinically localized prostate cancer (T1-T4, N0/NX, M0) received definitive radiation therapy in our department. By retrospective review of charts and questioning of patients, a record on the presence or absence of prostate cancer in a first degree relative was obtained in 1164 men. Univariate and multivariate analysis was performed on these cases with relapse or rising prostate-specific antigen (PSA), local recurrence, metastasis, and survival as endpoints. RESULTS: Familiar prostate cancer was present in 148 of 1164 men (13%). Men with familial disease were slightly but significantly younger (mean 66 years) at diagnosis than those with sporadic disease (mean 68 years) (p = 0.02). Apart from this there were no significant differences between the two groups in T-stage, Gleason score, pretreatment PSA levels, DNA ploidy, or serum testosterone levels. There were no significant differences in treatment parameters including radiation dose and the use of adjuvant androgen ablation. With a median follow-up of 42 months, there was no difference in freedom from relapse or rising PSA at 6 years between those with a family history (54%) and those without a family history (58%) (p = 0.171). Likewise there was no difference between the two groups when local recurrence or metastasis was the endpoint. Multiple subgroup analyses (younger and older; T1/T2 and T3; low Gleason and high Gleason; no androgen ablation and androgen ablation; race) failed to reveal any differences in outcome in any category between familial and sporadic disease. Among patients with a rising post-treatment PSA profile, PSA doubling times were similar in those with sporadic and familial disease. CONCLUSIONS: This study provides no evidence for any substantial difference between familial and sporadic prostate cancer either in clinicopathological features, in response to treatment, or in ultimate outcome.