[Mid-Term to Long-Term Results of Revision Total Hip Arthroplasty Using the Oval-Shaped Acetabular Cup - TC Type]. / Strednedobé az dlouhodobé výsledky reimplantací totální náhrady kycelního kloubu pri pouzití oválné revizní jamky ­ typ TC.

INTRODUCTION The purpose of our paper is to evaluate the mid-term to long-term results and to confirm the basic criteria of a high-quality revision implant: safe bridging of bone defects, achievement of reliable primary fixation of revision acetabular cup, achievement of good secondary stability with documentable osteointegration of cup and demonstration of remodelling of transplanted bone tissue in the area of defects and in spaces between the implant ribs. MATERIAL AND METHODS Altogether 36 patients (38 cups) were evaluated who had undergone revision hip arthroplasty in the period from 2004 to 2010. The mean follow-up was 8.2 years (5.1-11.6 years after the reimplantation, more than 10 years in 16 patients who underwent surgery). The position and osseointegration of the implant were assessed by digital radiography, the remodelling of transplanted bone tissues in the area of defects and between the implant ribs by computed tomography with reducing artefacts around the metal implant (Aquilion 64 - Toshiba Medical Systems), and for the clinical outcomes the Harris Hip Score was used. RESULTS Preoperatively, the condition of the hip joint based on the Harris Hip Score was in 30 cases evaluated as poor, in 8 patients as satisfactory. At the time of final evaluation, 8 patients achieved excellent results, in 19 patients the condition of the joint was very good (in 2 patients bilaterally), in 6 patients it was considered satisfactory and in 3 patients poor. The mean value for HHS increased from 39.5 to 84.5. Based on the radiography evaluation, in 27 patients (in 2 patients bilaterally) the osseointegration of the revision cup was good, in 8 cases with a radiolucent line of 2-4 mm in width in DeLee zone III, in one case proximal migration of the cup occurred caused by deep infection. The informed consent form for pelvic CT was signed by 25 patients of our cohort. Remodelling of bone tissue in the space between the ribs of the implant was always detected, the presence of bone cysts was not reported, the bone defects following the application of autologous spongioplasty in the monitored patients were healed. In 6 patients, an ingrowth of fibrous tissue of 2-4 mm in width in the convexity of the cup was detected. The mean survival of the revision oval-shaped cup - TC type with a follow-up of 8.2 years after the reimplantation based on Kaplan-Meier analysis was 91.4 %. DISCUSSION The number of revision total hip arthroplasties due to a younger age of patients who undergo alloplasty keeps growing. The choice of a revision implant should always match the intraoperative finding and the bone tissue quality. The standard uncemented implants with osteoactive surface can be opted for when anterior and posterior column of the acetabulum are intact (IIA and IIB according to Paprosky). Starting from type IIC, also the proximal part of acetabulum shall be considered. At our department, preference is given to the revision cup - TC type. The oval shape facilitates a lower degree of bone resection and easier restoration of the anatomical centre of rotation. Careful debridement of granulating and necrotic tissue, thorough treatment of bone defects and osteoactive surface of implants in case of adequate primary fixation of the cup substantially contribute to the quality of its osseointegration. Greater rigidity of fixation verified by pull-out tests enables to insert angular stable screws into the gaps in the proximal part of the cup. There is still room for improvement in treating the bone defect. The application of allogenic bone grafts into the defects and spaces between the ribs of the TC cup is more challenging than the use of augmentation in the systems with trabecular titanium. Based on the evaluation of CT scans, remodelling of the transplanted bone occurs, therefore the defect zone is reduced. CONCLUSIONS The oval-shaped uncemented cup - type TC meets the requirements placed on a state-of the art revision implant, moreover its specific construction helps improve the conditions where another re-operation of acetabulum is necessary. By evaluating mid-term to long-term results of non-homogenous group of 36 patients (38 cups) we have obtained data on joint function comparable to similar groups with revision uncemented implants presented in our and foreign literature. Key words: revision oval-shaped cup, bone remodelling, pull-out tests, angular stable screws, computed tomography.

Infrared predissociation vibrational spectroscopy of Li⁺(H2O)(3-4)Ar(0,1) reanalyzed using density functional theory molecular dynamics.

The experimental IR-PD (infrared predissociation) spectra of Li(+)(H2O)(3-4)Ar and Li(+)(H2O)(3-4) clusters, monitoring two different loss channels and thus different temperatures, have been reanalyzed using DFT-MD (density functional theory based molecular dynamics) simulations for finite temperature and anharmonic theoretical spectroscopy. The use of DFT-MD to calculate IR-PD spectra at low and elevated temperatures was found remarkably accurate and useful in precise structural characterization. The dynamical spectra have in particular provided the opportunity to estimate the clusters temperatures in the IR-PD experiments. The temperatures for Li(+)(H2O)(3-4)Ar are estimated at 50-60 K whereas Li(+)(H2O)3 and Li(+)(H2O)4 have been estimated at around 500-600 and 400 K, respectively.

Balloon dilatation of pediatric subglottic laryngeal stenosis during the artificial apneic pause: experience in 5 children.

INTRODUCTION: Balloon dilatation is a method of choice for treatment of laryngeal stenosis in children. The aim of procedure in apneic pause is to avoid new insertion of tracheostomy cannula. PATIENTS AND METHODS: The authors performed balloon dilatation of subglottic laryngeal strictures (SGS) in 5 children (3 girls and 2 boys) without tracheotomy. Two of them with traumatic and inflammatory SGS had a tracheal cannula removed in the past. The other 3 children with postintubation SGS had never had a tracheostomy before. The need for tracheostomy due to worsening stridor was imminent for all of them. RESULTS: The total of seven laryngeal dilatations by balloon esophagoplasty catheter in apneic pause was performed in the 5 children. The procedure averted the need for tracheostomy placement in 4 of them (80%). Failure of dilatation in girl with traumatic stenosis and concomitant severe obstructive lung disease led to repeated tracheostomy. CONCLUSION: Balloon dilatation of laryngeal stricture could be done in the absence of tracheostomy in apneic pause. Dilatation averted threatening tracheostomy in all except one case. Early complication after the procedure seems to be a negative prognostic factor for the outcome of balloon dilatation.

High energy conformers of M(+)(APE)(H2O)(0-1)Ar(0-1) clusters revealed by combined IR-PD and DFT-MD anharmonic vibrational spectroscopy.

IR-PD vibrational spectroscopy and DFT-based molecular dynamics simulations are combined in order to unravel the structures of M(+)(APE)(H2O)0-1 ionic clusters (M = Na, K), where APE (2-amino-1-phenyl ethanol) is commonly used as an analogue for the noradrenaline neurotransmitter. The strength of the synergy between experiments and simulations presented here is that DFT-MD provides anharmonic vibrational spectra that unambiguously help assign the ionic clusters structures. Depending on the interacting cation, we have found that the lowest energy conformers of K(+)(APE)(H2O)0-1 clusters are formed, while the lowest energy conformers of Na(+)(APE)(H2O)0-1 clusters can only be observed through water loss channel (i.e. without argon tagged to the clusters). Trapping of higher energy conformers is observed when the argon loss channel is recorded in the experiment. This has been rationalized by transition state energies. The dynamical anharmonic vibrational spectra unambiguously provide the prominent OH stretch due to the OH···NH2 H-bond, within 10 cm(-1) of the experiment, hence reproducing the 240-300 cm(-1) red-shift (depending on the interacting cation) from bare neutral APE. When this H-bond is not present, the dynamical anharmonic spectra provide the water O-H stretches as well as the rotational motion of the water molecule at finite temperature, as observed in the experiment.

[Li-Fraumeni syndrome - a proposal of complex prevention care for carriers of TP53 mutation with total-body MRI]. / Li-Fraumeni syndrom - návrh komplexní preventivní péce o nosice TP53 mutace s pouzitím celotelové magnetické rezonance.

Li-Fraumeni syndrome (LFS) is one of the most serious hereditary cancer syndromes with high risk of malignancy already in childhood. Adrenocortical carcinoma, brain tumor, leukemia, sarcoma are the most frequent malignancies in children. Early breast cancer, brain tumor, sarcoma, skin cancer, gastrointestinal, lung, gynecological, hematological and other malignancies can be seen in adults. Predictive testing in families with detected LFS and TP53 mutation is offered from the age of 18 for various reasons. One of the most important reasons is a very limited effectivity of prevention especially in children, also the possible risk of psychological harm to the child and his family caused by the diagnosis of this syndrome. Progress in diagnostic methods, especially total body MRI, enables to propose preventive care for early cancer diagnoses for children and adults. Biochemical tests, ultrasound, MRI may improve survival of these high risk individuals and support the possibility of predictive testing in children.

Infrared spectra and ab initio calculations for the F- -(CH4)n (n = 1-8) anion clusters.

Infrared spectra of mass-selected F- -(CH4)n (n = 1-8) clusters are recorded in the CH stretching region (2500-3100 cm-1). Spectra for the n = 1-3 clusters are interpreted with the aid of ab initio calculations at the MP2/6-311++G(2df 2p) level, which suggest that the CH4 ligands bind to F- by equivalent, linear hydrogen bonds. Anharmonic frequencies for CH4 and F--CH4 are determined using the vibrational self-consistent field method with second-order perturbation theory correction. The n = 1 complex is predicted to have a C3v structure with a single CH group hydrogen bonded to F-. Its spectrum exhibits a parallel band associated with a stretching vibration of the hydrogen-bonded CH group that is red-shifted by 380 cm-1 from the nu1 band of free CH4 and a perpendicular band associated with the asymmetric stretching motion of the nonbonded CH groups, slightly red-shifted from the nu3 band of free CH4. As n increases, additional vibrational bands appear as a result of Fermi resonances between the hydrogen-bonded CH stretching vibrational mode and the 2nu4 overtone and nu2+nu4 combination levels of the methane solvent molecules. For clusters with n < or = 8, it appears that the CH4 molecules are accommodated in the first solvation shell, each being attached to the F- anion by equivalent hydrogen bonds.

Acute gastro-intestinal obstruction as a late presentation of congenital diaphragmatic hernia. A report of three cases.

Three cases of acute gastro-intestinal obstruction due to incarceration of congenital diaphragmatic hernia (Bochdalek hernia) in infants are reported. The level of incarceration was stomach, small and large intestine. All of the presented posterolateral diaphragmatic defects were small and without a sac. History of trauma was absent in all patients. Two girls recovered well while a boy died of intracerebral bleeding one month after surgery. Acute gastro-intestinal obstruction as a late, post neonatal, presentation of congenital diaphragmatic hernia is a rare, life-threatening emergency. The combination of gastro-intestinal obstruction, circulatory and respiratory distress requires urgent gastro-intestinal decompression, fluid resuscitation and ventilatory support. Surgery can be performed safely only after pre-operative stabilization.

[Surgical complications following oesophageal replacement by stomach in childhood]. / Chirurgické komplikace po náhrade jícnu zaludkem v detském veku.

AIM: Assessment of surgical complications and options for their therapy following replacement of oesophagus by stomach. METHODOLOGY AND MATERIAL: A retrospective study of clinical and pathological data collected from 25 children, who underwent replacement procedures of their oesophagus by stomach during the 1992-2005 period. 18 subjects were indicated for the procedure for oesophageal atresia with large stubs distance and 7 subjects were indicated for extensive oesophageal strictures following acid burns. RESULTS: The study group included 25 children whose mean age at the time of the procedure was 12.5 years (the age range 8 to 13.3 years). Early postoperatively, a fistule in the oesophageal anastomosis region was confirmed in 7 subjects (28%), however, in all cases it healed successfully on conservative management. In five cases (20%), a stricture in the pyloric region developed and in 4 cases it was managed using balloon dilation. During the long-term follow up period, oesophageal anastomosis strictures were diagnosed in 9 children (36%). The problem was managed using repetitive balloon dilations. One child was operated for ileus with adhesions and in one child, a nutritional jejunostomy had to be re-conducted. One girl exited at home, a year following the procedure, due to respiratory arrest on aspiration. CONCLUSIONS: Transposition of the stomach is a suitable method of choice for oesophageal replacement in childhood, providing good quality of life for majority of patients. Early and late surgical complications correspond with a degree of seriousness of the disorder and require treatment and long term follow up to be conducted in a specialized clinic.

Infrared spectra of the Cl- -C2H4 and Br- -C2H4 anion dimers.

Infrared spectra of mass-selected Cl- -C2H4 and Br- -C2H4 complexes are recorded in the vicinity of the ethylene CH stretching vibrations (2700-3300 cm(-1) using vibrational predissociation spectroscopy. Spectra of both complexes exhibit 6 prominent peaks in the CH stretch region. Comparison with calculated frequencies reveal that the 4 higher frequency bands are associated with CH stretching modes of the C2H4 subunit, while the 2 weaker bands are assigned as overtone or combinations bands gaining intensity through interaction with the CH stretches. Ab initio calculations at the MP2/aug-cc-pVDZ level suggest that C2H4 preferentially forms a single linear H-bond with Cl- and Br- although a planar bifurcated configuration lies only slightly higher in energy (by 110 and 16 cm(-1), respectively). One-dimensional potential energy curves describing the in-plane intermolecular bending motion are developed which are used to determine the corresponding vibrational energies and wavefunctions. Experimental and theoretical results suggest that in their ground vibrational state the Cl- -C2H4 and Br- -C2H4 complexes are localized in the single H-bonded configuration, but that with the addition of modest amounts of internal energy, the in-plane bending wavefunction also has significant amplitude in the bifurcated structure.

Multiple fibroepithelial polyps of the upper ureter in a 17-year-old boy--case report and review of the literature.

Benign tumours and primary malignant tumours of the ureter are uncommon in adults and extremely rare in children. The clinical symptoms are flank pain, urinary tract infection, and macro/micro-haematuria. There is an incomplete ureteral obstruction and filling defect on intravenous urography (IVU). Optimum treatment of this lesion results in renal preservation. Uretero-renoscopy is currently the best method available for the identification and histological diagnosis of ureteral polyps. Recommended operative procedures are pyeloureteric junction (PUJ) resection with Anderson-Hynes pyeloplasty, ureteric resection with end-to-end anastomosis or with uretero-cysto-neoanastomosis (UCNA), ureteric resection with renal autotransplantation. Ureteronephrectomy is not indicated. A case of ureteral polyps in a 17-year-old boy with the chief complaint of left flank pain is reported here. The excretory urogram and renal scan showed left hydronephrosis. Resection of the pyeloureteral junction, partial resection of the upper ureter containing the lesions--multiple branching 30-40 mm long polyps with a common basis--and Anderson-Hynes pyeloplasty were performed. The pathological diagnosis was benign fibroepithelial polyps of the ureter. Convalescence was uneventful and after 4 years of follow-up, excretory urogram and ultrasonography showed good renal function and improvement of hydronephrosis.

[Esophageal reconstruction using the stomach in children]. / Náhrada jícnu zaludkem v detském veku.

The authors present an account of their experience with oesophageal replacement by gastric transposition in 10 children during the period between November 1992 and January 1999. Indications for oesophageal replacement was in seven children atresia of the oesophagus at the age of 9-36 months and in three children (2.5, 3 and 14 years) a long stricture of the oesophagus after caustic injury which did not respond to balloon dilatation. Replacement after caustic injury was made in children aged 2.5, 3 and 14 years. In eight patients the replacement was made without thoracotomy, by blunt resection of the mediastinum, in two patients after caustic injury thoracotomy had to be performed. In three patients after surgery a temporary fistula developed at the site of anastomosis which healed spontaneously. Eight patients are in a satisfactory condition after surgery, one patient five months after operation swallows with difficulty, his birth weight was 1500 g. One female patient died one year after oesophageal replacement, apparently due to aspiration and respiratory arrest. Gastric transposition is a considerate and relatively simple method in child age. The functional results are favourable.

Long-term outcomes of balloon dilation of esophageal strictures in children.

RATIONALE AND OBJECTIVES: The purpose of this study was to determine the long-term success of the use of angioplasty balloons for dilation of esophageal strictures in children. MATERIALS AND METHODS: The authors studied 24 children who had undergone fluoroscopically guided angioplasty balloon dilation of esophageal strictures. Ten children had stricture of the anastomosis after surgical repair of esophageal atresia; five had achalasia; three had strictures due to gastroesophageal reflux; three had corrosive strictures; two had congenital stenosis; and one had stricture after radiation therapy. Success was defined as resolution of the dysphagia a year after dilation. RESULTS: A year after the last dilation, 15 of the 24 children had no dysphagia. Patients in whom treatment was successful included eight children with strictures after surgery for esophageal atresia, one with achalasia, three with strictures caused by gastroesophageal reflux, one with a corrosive stricture, one with congenital stenosis, and one with a stricture resulting from radiation therapy. CONCLUSION: The long-term results of balloon catheter dilation are highly successful in patients with stricture after surgical repair of esophageal atresia and stricture due to gastroesophageal reflux. Dilation is not as valuable in the treatment of esophageal strictures resulting from other causes.