Exploring the impact of intensified multiple session tDCS over the left DLPFC on brain function in MCI: a randomized control trial.

Transcranial direct current stimulation combined with cognitive training (tDCS-cog) represents a promising approach to combat cognitive decline among healthy older adults and patients with mild cognitive impairment (MCI). In this 5-day-long double-blinded randomized trial, we investigated the impact of intensified tDCS-cog protocol involving two trains of stimulation per day on working memory (WM) enhancement in 35 amnestic and multidomain amnestic MCI patients. Specifically, we focused to improve WM tasks relying on top-down attentional control and hypothesized that intensified tDCS would enhance performance of visual object matching task (VOMT) immediately after the stimulation regimen and at a 1-month follow-up. Secondarily, we explored whether the stimulation would augment online visual working memory training. Using fMRI, we aimed to elucidate the neural mechanisms underlying the intervention effects by analyzing BOLD activations during VOMT. Our main finding revealed no superior after-effects of tDCS-cog over the sham on VOMT among individuals with MCI as indicated by insignificant immediate and long-lasting after-effects. Additionally, the tDCS-cog did not enhance online training as predicted. The fMRI analysis revealed brain activity alterations in right insula that may be linked to tDCS-cog intervention. In the study we discuss the insignificant behavioral results in the context of the current evidence in tDCS parameter space and opening the discussion of possible interference between trained cognitive tasks.

How we decide when to immobilize the wrist after stable osteosynthesis of displaced distal radius fracture.

PURPOSE OF THE STUDY:  Fractures of the distal radius are frequently associated with injuries of the scapholunate (SL) and lunotriquetral (LT) ligaments. Our study is aimed at revealing their hidden lesions by employing a fast and accessible fluoroscopic identification. PATIENTS AND METHODS:  We investigated 40 patients who were indicated for plate osteosynthesis of distal radius fracture. After completing the osteosynthesis, the procedure was concluded with a wrist arthrography. The patients with SL and LT interval lesions had their wrists immobilized by a plaster splint while patients with normal findings with an elastic bandage. The patients were followed up for 12 months after the surgery. The functional results were evaluated by Mayo wrist score. RESULTS: The intra-operative examination identified 62.5 % of patients with lesions of SL and/or LT interval, and 37.5 % of patients were lesion-free. The Mayo wrist scores after 3, 6 and 12 months in patients whose wrists were not immobilized were 72, 86.3, and 86.3, respectively. The latter scores in the group of patients with external immobilization were 54.4, 82, and 84.8, respectively. The difference between the groups was significant three months after the surgery. After six and twelve months, the difference became negligible. CONCLUSION:  The exclusion of hidden lesions allows earlier rehabilitation, while in patients with signs of lesions, it is appropriate to immobilize the wrist (Tab. 1, Fig. 3, Ref. 31). Text in PDF www.elis.sk Keywords: distal radius fractures, scapholunate ligament, lunotriquetral ligament, fluoroscopic, diagnosis.

Cognitive Aftereffects of Acute tDCS Coupled with Cognitive Training: An fMRI Study in Healthy Seniors.

Enhancing cognitive functions through noninvasive brain stimulation is of enormous public interest, particularly for the aging population in whom processes such as working memory are known to decline. In a randomized double-blind crossover study, we investigated the acute behavioral and neural aftereffects of bifrontal and frontoparietal transcranial direct current stimulation (tDCS) combined with visual working memory (VWM) training on 25 highly educated older adults. Resting-state functional connectivity (rs-FC) analysis was performed prior to and after each stimulation session with a focus on the frontoparietal control network (FPCN). The bifrontal montage with anode over the left dorsolateral prefrontal cortex enhanced VWM accuracy as compared to the sham stimulation. With the rs-FC within the FPCN, we observed significant stimulation × time interaction using bifrontal tDCS. We found no cognitive aftereffects of the frontoparietal tDCS compared to sham stimulation. Our study shows that a single bifrontal tDCS combined with cognitive training may enhance VWM performance and rs-FC within the relevant brain network even in highly educated older adults.

[Comparison of 2-Screw Implant and Antirotational Blade Implant in Treatment of Trochanteric Fractures]. / Porovnanie dvojskrutkového implantátu a antirotacnej cepele pri liecbe trochanterických zlomenín femuru.

PURPOSE OF THE STUDY Surgical treatment of trochanteric fractures with intramedullary nailing still remains controversial as to which nail design is the best with no postoperative complications. The purpose of this study was to provide a comparative evaluation of complications in the treatment of trochanteric fractures using 2-screw proximal femoral nail versus proximal femoral anti-rotational blade nail. MATERIAL AND METHODS A retrospective review was conducted between March 2013 and March 2019. The study included 519 patients (358 females and 161 males) treated surgically for trochanteric fractures. The mean age was 79.8±12.0 (24-100) years. A1.2 type of fracture occurred in 153 (29.5%) cases, A1.3 type in 155 (29.9%), A 2.2 type in 90 (17.4%), A2.3 type in 95 (18.3%), A3.1 type in 11 (2.1%), A3.2 type in 7 (1.3%) and A3.3 type in 8 (1.5%) cases. Patients were treated either by 2-screw nail PFN (393 patients (75.7%) or by anti-rotational blade nail PFNA (126 patients (24.3%). RESULTS Our primary objective was to evaluate the implant related complications (e.g. cut-out, back-out, irritation, peri-implant fractures). Other complications (infection) and revision surgeries were also recorded. Complications were observed in 38 (9.7%) patients with PFN nail and 7 (5.6 %) patients with PFNA blade nail (p = 0.15). Screw back-out (n = 11) and cut-out (n = 11) were the most frequent complications in patients treated by 2-screw PFN nail and occurred in 5.6%. In the PFNA group, cutout occurred in 1.6% (n = 2) of cases while no cases of back-out were reported. Infection (n=3) was the most common complication in the latter group and represented 2.4%. In the PFN group the infection rate was 2.3% (n = 9). There were no statistically significant differences between both the groups considering implant-related complications (p = 0.14) and infections (p = 1.0). Revision surgery was performed in 33 patients (66.7%). DISCUSSION Biomechanical studies of intramedullary nails suggest good results with minimal complications if a two-screw implant is used. When antirotational blade is used, compression of spongiosis around blade is observed, which increases stability, especially in an osteoporotic bone. In our study, complications in these two types of nails were retrospectively compared. Considered as the limitation of our study is the retrospective nature of evaluation, which made it impossible the create two study groups with equal or similar number of patients, to follow up the patients postoperatively for a long period of time and to evaluate fracture union and limb function. CONCLUSIONS In our study no statistically significant difference in postoperative mechanical and infectious complications was confirmed between the 2-screw proximal femoral nail and the proximal femoral nail with antirotational blade. We have arrived at the conclusion that both types of nails are equivalent in treating trochanteric fractures. Key words: intramedullary nail, screw, blade, trochanteric fracture, complication.

[Comparison of Two Surgical Approaches for Osteosynthesis of Intraarticular Distal Humerus Fractures and Suggested New Treatment Algorithm for These Fractures]. / Porovnanie dvoch operacných prístupov pri osteosyntéze intraartikulárnych zlomenín distálneho humeru a návrh nového algoritmu osetrenia týchto zlomenín.

PURPOSE OF THE STUDY The standard procedure in treating distal humerus fractures is the open reduction internal fixation (ORIF). The surgical approach is still a matter of discussion. The submitted study focuses on comparing the conventional approach with olecranon osteotomy and the paratricipital approach. MATERIAL AND METHODS Since January 2015 a total of 18 patients have been operated on, who met the inclusion criteria of the study on type C distal humerus fracture without the use of olecranon osteotomy. This group of patients was subsequently compared with a control group of patients in whom the olecranon osteotomy was performed in the period 2010-2015. The patients were assessed using the Mayo Elbow Performance Score (MEPS), the range of motion and complications, including the need for removal of osteosynthesis material. RESULTS The control group (Group 1), in which 22 patients operated directly by olecranon osteotomy were assessed, was compared with the group of operated patients (Group 2) consisting of 18 patients. When comparing the range of motion and MEPS, no significant difference was found between the groups (flexion: p = 0.519, extension: p = 0.382, MEPS: p = 0.110). Unlike Group 2, in Group 1 the osteosynthesis material of cerclage was removed in 13 cases. DISCUSSION Apart from the complexity of fracture and choice of fixation technique, it is the choice of surgical approach which constitutes another factor having effect on the final elbow function. Basically, the approaches to distal humerus can be divided into 4 groups, namely splitting, reflecting and sparing approaches and olecranon osteotomy which offers the best access to the fracture during fixation and which is recommended by many experts in treating these complex fractures which, however, has its disadvantages such as longer duration of surgery, longer healing time, non-union or malunion, protruding osteosynthesis material and secondary procedures necessary to remove the material. CONCLUSIONS In our study no significant difference in functional outcomes was found between the examined approaches. A difference was identified with respect to protruding material of the cerclage and soft tissue irritation with subsequent removal of osteosynthesis material after the olecranon osteotomy. Key words:distal humerus fracture, internal fixation, surgical approach, olecranon osteotomy, paratricipital approach, tricepssparing approach, triceps reflecting anconeus pedicle approach.

[Conservative treatment of acetabular fractures: epidemiology and medium-term clinical and radiological results]. / Konzervatívna liecba zlomenín acetabula: epidemiológia a strednodobé klinické a rádiologické výsledky.

PURPOSE OF THE STUDY: The vast majority of studies on fractures of the acetabulum are concerned with surgical treatment. All displaced fractures are presented as surgically treated. The purpose of this study was to evaluate the results of surgical and conservative treatment of patients with acetabular fractures in relation to the degree of fracture displacement. MATERIAL AND METHODS: We analysed 140 fractures of the acetabulum treated in our institution by different methods between 2009 and 2013. In addition to the use of Letournel´s classification, we allocated each fracture to one of six groups: 1. Sixty displaced fractures treated surgically, 2. Twenty three fractures with a displacement of more than 6 mm, 3. Eighteen slightly displaced fractures (2-3 mm in the acetabular roof or 4-5 mm in other parts of the acetabulum), 4. Twenty non-displaced fractures, 5. Six pelvic fractures involving the acetabulum and 6. Thirteen fractures of old people, mostly displaced but not examined by CT. Groups 2 to 6 were treated conservatively. In all patients, demographic and epidemiologic factors were analysed in relation to the patient's group assignment. In 107 patients, hip function was assessed using the Matta clinical grading system at a minimum follow-up of 12 months (average 3.16 years). Radiological status, time of admission, start of weight-bearing after the accident, working ability, mortality and complications were also evaluated. RESULTS: Non-displaced fractures were often associated with serious injury or polytrauma in 20 patients; not all of them had excellent functional outcome. (mean score, 17.25). Excluding two patients who developed avascular necrosis, fourteen slightly displaced fractures had a fixal score of 16.92. Sixteen patients with displaced fractures were managed conservatively due to their poor medical condition and other circumstances. Their functional outcome (mean score, 15.25) was significantly worse than that of the patients with non-displaced fractures (p=0.02) and worse than the outcome in patients with slightly displaced fractures, but the difference was not significant (p=0.32). No occurrence of accelerated post-traumatic arthritis was observed in these groups. The mean clinical score of 14.80 and 60% of excellent and good results were achieved in surgically treated patients. Eight of them were treated by primary hip arthroplasty and osteosynthesis. A total of 11 patients required total hip arthroplasty because of post-traumatic osteoarthritis, but only one from the group of slightly displaced fractures, all others from the group of surgically treated patients. DISCUSSION: Displaced fractures of the acetabulum are best treated by open reduction and internal fixation. The type of fracture and the quality of reduction influence the functional outcome. There are a few studies reporting long-term outcomes in conservatively treated acetabular fractures. Although conservative treatment continues to be the mainstay of treatment in most centres in the developing countries, it is obvious that not all of acetabular fractures can or must be treated surgically or identically. We found that, in many cases, surgery was too dangerous for the patient and his/her medical condition or that the result of surgery was doubtful, mostly because of a late presentation. In some cases, primary hip arthroplasty is a solution. Secondary total hip replacement is technically more demanding and has a higher rate of failure. CONCLUSIONS: Conservative treatment is the method of choice for the treatment of non-displaced acetabular fractures. Excellent or very good results can also be expected in slightly displaced fractures if acetabular roof involvement is minor. In displaced fractures, if the result of surgery is doubtful under various circumstances or if high-risk medical conditions are present in the patient, conservative treatment can be the method of choice with satisfying results. Key words: acetabular fractures, conservative treatment, degree of displacement, epidemiology of acetabular fractures.

[Pedicle screw fixation of thoracic spine fractures]. / Transpedikulárna stabilizácia zlomenín hrudnej chrbtice.

PURPOSE OF THE STUDY: Fractures of the thoracic spine involve injury at the levels of Th2 to Th10. Because of pedicle morphology, pedicle screw fixation is a demanding procedure. However, evidence on the reliability and efficiency of this technique has recently been provided by several studies. The aim of this study was to analyse a group of patients with thoracic spine fractures treated by pedicle screw fixation and to evaluate treatment outcomes. MATERIAL AND METHODS: A total number of 33 patients treated by pedicle screw fixation for thoracic spine fractures between January 2007 and December 2011 were enrolled in this retrospective study. The mean age was 39.7 ± 16.7 years. The evaluation included demographic data, mechanism of injury, associated injuries, neurological status, fracture type (AO classification), levels of the fractured vertebrae, injury-surgery interval, type and duration of surgery, type and length of pedicle screw fixation and complications. The position of pedicular screws in relation to the pedicle walls and correction of kyphotic deformity were assessed on post-operative CT scans. RESULT: Of the 33 patients, 24 had associated injuries (72.7%), 22 had thorax injury (66.7%) and 17 had neurological deficit (51.5%). The most frequent spinal fracture type was type B2, 15 (45.5%); followed by type C, nine (33.3%); and type B1, five (15.1%). The mean injury-to-surgery interval was 5.2 ± 4.3 days. The mean operative time was 210 ± 56 min. The most frequently used configuration of pedicle screw fixation involving two segments above and two below the fracture level was used in 20 cases (58.8%). The position of 149 out of 282 pedicle screws (52.8%) was evaluated on post-operative CT scans as follows: 98 % of the pedicle screws were placed in acceptable positions, 76% were placed completely within pedicle borders. The mean pre-operative Cobb angle was 18.7° ± 8.2°, the mean post-operative Cobb angle was 9.3 ± 3.4°. Six intraoperative and three post-operative complications occurred. During follow-up no instrumentation failure or apparent loss of correction was recorded. DISCUSSION: Early stabilisation of thoracic spine fractures reduces the risk of complications, shortens the hospital stay and allows for faster recovery of patients. Early thoracic spine stabilisation is most beneficial in patients with a high ISS (Injury Severity Score). In the case of small-sized pedicles there is the possibility of pedicle screw insertion via an extrapedicular or parapedicular trajectory. Recommended pedicle screw fixation is two levels above and two levels below the fracture level. CONCLUSIONS: Pedicle screw fixation of thoracic spine fractures is a safe therapeutic method with a low risk of complications. It facilitates effective reduction and stable fixation with a low risk of secondary displacement and implant failure. Key words:transpedicular stabilisation, thoracic spine, fracture, pedicle screws.

[Surgical treatment of intra-articular calcaneal fractures]. / Operacná liecba intraartikulárnych zlomenín pätovej kosti.

PURPOSE OF THE STUDY The calcaneus is one of the most complex bones in the human body. If fractured, restoration of its anatomy is demanding and displaced fractures may have permanent consequences affecting both daily living and work activities of the patient. In this prospective study, the authors present the results of surgical treatment of 48 dislocated intra-articular fractures of the heel bone. MATERIAL In the period from September 2006 to September 2009, 48 dislocated intra-articular fractures in 41 patients were surgically treated at the Department of Trauma Surgery in Bratislava-Kramare. Seven (17 %) patients, six men and one woman, had bilateral calcaneal fractures. In the group of 41 patients, 32 (78 %) were men and nine (22 %) were women. The average age of the group was 41 years (range, 16 - 64 years). METHODS Based on computed tomography scans, the fractures (n=48) were classified according to the Sanders system into Sanders II to IV subgroups. This included 26 Sanders II fractures (54 %), 15 Sanders III fractures (31 %) and seven Sanders IV fractures (15 %). Minimally invasive reduction and osteosynthesis (MIOS) was used to treat 16 Sanders II fractures (33.33 %) and two Sanders IV fractures (4.16 %). Open reduction and internal fixation (ORIF) was employed in 10 Sanders II fractures (20.83 %), all 15 Sanders III fractures (31 %) and one Sanders IV fracture (2.08 %). Four comminuted fractures (8.33 %) classified as Sanders IV fractures were stabilised with an external fixator. The surgical technique was selected in accordance with the bone morphology, soft tissue condition and patient's overall state. RESULTS The patients were followed up for 6 to 36 months and clinical assessment was based on the Creighton Nebraska Health Foundation scoring system (C-N score) and the AOFAS Ankle-Hindfoot Scale (A-H score). The functional outcomes were excellent in 25 fractures (52 %), good in nine (18.75 %), less satisfactory in eight (16.6 %) and poor in six fractures (12.5 %). Complications of wound healing were recorded in three fractures (6.25 %) treated by ORIF, and only involved superficial marginal wound necrosis. There was no deep wound infection. Algodystrophic syndrome developed in two cases (4.16 %). X-ray measurements were used to assess the final Böhler's angle, whose value after treatment ranged from 8° to 38°, with an average of 27°. DISCUSSION At present the selection of an operative technique is being discussed. The advocates of MIOS emphasise a lower com- plication rate associated with wound healing and the possibility of using this technique when the treated tissues are in a critical condition. The advantage of ORIF lies in exact open reduction and stable osteosynthesis. CONCLUSIONS The method of percutaneous reduction and osteosynthesis is the optimal treatment for Sanders II dislocated fractures. Severely dislocated fractures (Sanders II and III) require open reduction and plate osteosynthesis. Comminuted fractures should be treated first by external fixation and by arthrodesis at the second stage if problems arise.

[Multicentric study of patients with pelvic injury: overview of clinical outcomes and permanent sequelae]. / Multicentrická studie pacientu s poranením pánve: prehled klinických výsledku a trvalých následku

PURPOSE OF THE STUDY: The aim of the study was to assess the clinical outcomes and permanent sequelae of pelvic fractures at one year after injury and to identify factors that influenced these results. MATERIAL AND METHODS: The group evaluated consisted of 151 patients older than 15 years treated for pelvic fractures in 2007 at seven hospitals in the Czech Republic and Slovakia. This one-year descriptive prospective study included all basic epidemiological data concerning the patients and the evaluation of their clinical results using the Majeed score. The obtained data were statistically analysed by the 2% test of independence and contingency tables at a 5% level of significance. For data obtained at a low frequency, only descriptive statistical methods were used. RESULTS: From the original group of 237 patients (101 women and 136 men), 16 died (7 women and 9 men) and 70 were lost for follow-up (28 women and 42 men), leaving 151 patients (64%) for evaluation. This final group comprised 66 women (44%) and 85 men (56%) with the age range of 16 to 82 and an average age of 42.7 years (women, 45.3 years; men, 40.7 years). Age distribution, causes of injury, types of pelvic fracture, associated injuries and methods of treatment in this group were similar to those in the original group. The clinical outcomes evaluated using the pelvic Majeed score were excellent and good in 85%, fair in 12% and poor in 3% of the patients. The prediction of clinical outcome was more accurate when based on the extent of dislocation of the dorsal segment after fracture healing than on the type of pelvic fracture The permanent sequelae were recorded in 22 patients (15%) and a total of 43 specific complaints were identified; some patients had multiple sequelae involving neurological, urological and sexual problems. Neurological deficit was related to the type of pelvic injury and its highest occurrence was associated with type C pelvic fractures. Permanent neurological deficits were found in 15 patients (10% of patients in the final group), of whom 10 were diagnosed early after injury as having neurological lesions (7% of the final group) and in five the diagnosis was made after surgery (8 %of surgically treated patients). Fifteen permanent urological disorders were recorded in 13 patients and they also were most frequent in type C fractures. However, they were more strongly associated with primary urethral injury and primary or post-operative neu-rogenic lesions. Sexual sequelae were also found in association with type C fractures; almost all patients with these problems had injury to the lower urinary tract or neurogenic lesions. Permanent gastrointestinal sequelae were in three patients; all of them sustained unstable pelvic fractures and were diagnosed with post-operative neurogenic lesions. DISCUSSION: Based on the evaluation of basic patient data, the patient group described here can be regarded as a representative sample of the originally treated patients. Therefore, in the authors' view, the results presented here can be taken as valid. In agreement with other authors, the study recorded poorer clinical outcomes in the patients with more serious types of pelvic injury, and dramatically worse results in relation to the extent of dislocation of the dorsal segment after the pelvic fracture had healed. The authors confirmed that permanent neurological and urological sequelae occur more frequently in patients with a more serious pelvic injury. Urological and sexual problems were more often associated with the presence of neurologi- cal deficit than with the type of pelvic fracture and injury to the lower urinary tract. CONCLUSIONS: The evaluation of patient data at one year after pelvic injury in this prospective longitudinal study justify the authors to draw the following conclusions: clinical outcomes were worse in unstable pelvic fractures; worse clinical results were related to the extent of residual dislocation of the dorsal pelvic segment; permanent neurological sequelae were most frequent and were perceived by the patients with strong negative feelings particularly when they manifested clinically after surgery; permanent urological, sexual and gastrointestinal problems were more closely associated with neurological deficits than with the severity of primary injury to the pelvic skeleton, lower urinary tract, sexual organs or digestive system.

[Multicentric study of patients with pelvic injury: basic analysis of the study group]. / Multicentrická studie pacientu s poranením pánve: základní analýza souboru.

PURPOSE OF THE STUDY: The aim of the study was to make a basic analysis of the patients treated for pelvic fractures in the year 2007 at 14 institutions in the Czech Republic and Slovakia. MATERIAL AND METHODS: The group investigated consisted of 474 patients treated in 2007. In a one-year prospective descriptive study, patients' data were recorded according to a unified protocol. They included age, gender, mechanism of injury, fracture type, associated injuries, method of treatment, post-operative complications, length of hospital stay, injury/surgery-to-standing time and number of deaths during primary hospitalization.The ?2 test of independence in a contingency table was used to compare categorical data. The level of significance for the test was set at 5%. RESULTS: The group comprised 192 women and 282 men with an average age of 45.9 years (range, 15 to 95). In men, the frequency of pelvic fractures was significantly higher (p<0.001), because men significantly outnumbered women in the largest middle-age categories (30 to 59 years). Pelvic fractures were significantly higher only in women over 80 years of age. The most frequent cause of injury was a road traffic accident (237 patients, 50%). Significantly more men than women were injured in motorbike accidents (p=0.015), due to a fall from height (p=0.001) or by a falling object (p=0.040).Women more frequently suffered injury as a result of a suicidal attempt by jumping (p=0.051) or a simple fall (p<0.001). Type A2.2 fractures (115 patients, 24%; average age, 51.8 years) and type B2.1 (77 patients, 16%; average age, 43.5 years) were most frequent. In 248 patients (52%), a pelvic fracture was part of multiple trauma. These patients had an average ISS of 30 points. Conservative treatment was used in 287 patients (61%). In 71 patients, skeletal traction (30 patients, 6%), C-clamp (19 patients, 4%) or external fixation (22 patients, 5%) was temporarily applied during the primary treatment. Surgery was carried out in 187 patients (39%). The average operative time was 114 minutes (range, 45 to 315) Post-operative complications were recorded in 58 patients (30% of the surgically treated). The most frequent local com- plication was wound infection (11 patients, 6%). The average hospital stay was 27 days (range, 2 to 266); 181 patients (38%) required care at an anaesthesia and acute care department for an average of 14 days (range, 1 to 127). The injury/surgery-to-standing time was 30 days on average (range, 2 to 118 days). Twenty-six patients; nine women and 17 men (5%), died during primary hospitalization. Their average age was 62.5 years (74.1 years in women and 56.4 years in men). DISCUSSION: The higher number of injured men in the middle-age categories suggests a more risky behaviour of these men in driving motor cars and motorbikes and at work (falls from height, objects falling on them).Women significantly outnumbered men in simple falls (which can be explained by a higher occurrence of pubic ramus fractures due to osteoporosis in women at a higher age) and a difference at the margin of statistical significance was recorded in suicidal attempts (any explanation is beyond the scope of this study as well as beyond the field of trauma medicine). The higher number of type A2.2 and also type B2.1 fractures can too be explained by a higher occurrence of these fractures due to simple falls in elderly women with osteoporosis. CONCLUSIONS: The evaluation of the basic demographic and epidemiologic data of patients with pelvic fractures included in this multi- centre study revealed the following facts: pelvic fractures were significantly more frequent in men; the most frequent cause of pelvic fracture was a road traffic accident; the number of injured men was highest at age 40 to 50, in motorbike accidents, falls from height and in injuries by falling objects; women outnumbered men at the age category over 80 and in suicidal jumping from a height; the most frequent types of fractures were those affecting osteoporotic bone in elderly women (A2.2, B2.1); surgical treatment of pelvic fractures was associated with a relatively high number of complications; death during primary hospitalization was higher in elderly patients. Key words: pelvic fracture, demography, epidemiology, type of fracture, associated injuries.

Nonisothermal kinetics of acrylamide elimination and its acceleration by table salt--a model study.

Acrylamide was applied onto table salt and heated in a glass reaction vessel within the temperature range 50 to 210 degrees C with a heating rate of 2 degrees C/min in order to study the influence of temperature and table salt on acrylamide elimination. For comparison purposes, pure acrylamide was also heated at the same conditions to 190 degrees C. Both systems were analyzed for acrylamide amount by GC-MS. During heating, the amount of acrylamide in contact with table salt decreased from 99.9 to 67.7 microg while the amount of acrylamide without table salt decreased from 99.9 to 81.3 microg, obviously due to polymerization reactions taking place in both studied systems. Comparing the results it was found that table salt has substantial catalytic effects on the polymerization reactions. Based on the treatment of experimental results, the parameters characterizing the kinetics of acrylamide polymerization, for example, the rate of its elimination at nonisothermal conditions, have been obtained, also making possible the calculation of rate constant values for any temperature in isothermal regime. As concluded, the polymerization may represent one of conceivable pathways of acrylamide elimination in a real food matrix.

[Early primary total hip arthroplasty for acetabular fractures in elderly patients]. / Vcasná primárna implantácia totálnej protézy pri zlomeninách acetabula u pacientov pokrocilého veku.

PURPOSE OF THE STUDY: The aim of this pilot study was to evaluate the clinical and functional outcomes of total hip arthroplasty (THA) in patients with acetabular fractures due to a low-energy injury. Acute primary THA included an antiprotrusion cage and autologous bone grafting of the acetabulum. This prospective study was carried out between 1998 and 2004. MATERIAL: Ten patients, of whom six were men, (average age, 71 years; range, 60 to 83 years) with acetabular fractures were treated by THA. Two patients had type A2, two had type B1, three had type B2 and three had type B3 fractures, as assessed by the AO classification. X-ray showed osteoporosis due to decreased bone mass in all patients, and dislocations of the fragments in the weight-bearing area of the joint exceeded 1 cm. The average follow-up was 36 months. METHODS: Indications for primary THA included, in addition to higher age, displacement in the fracture line exceeding 1 cm, a fracture line extending to the weight-bearing part of the acetabulum, presence of hip arthritis, cartilage injury, defects of the weight-bearing area of either the femoral head or acetabulum, and Pipkin type IV injury. The interval between accident and surgery ranged from 6 to 12 days (average, 9.5). Three surgical techniques were used, namely, cemented THA with a polyethylene cup cemented into an acetabulum-stabilizing cage; reconstruction with a cementless RSC acetabular component; internal fixation using screws and a cemented cup. Bone grafting of the acetabulum was used in all patients. Evaluated were basic operative parameters, complications, X-ray findings, ability to walk and Merle d'Aubigne scores. RESULTS: The average operative time was 100 min, the average blood loss was 1000 ml. Hip motion showed the following average values: flexion, 110 degrees ; extension, 10 degrees ; rotation, 30 degrees -0 degrees -30 degrees ; adduction, 25 degrees ; abduction, 35 degrees . All patients returned to their preoperative range of motion. X-ray examination showed good reduction, bone graft was completely incorporated in the acetabulum, and no displacement or signs of loosening or graft migration were recorded. Two patients had Brooker type I heterotropic ossification. The final evaluation of function at 36 months on the basis of the Merle d'Aubigne classification showed excellent and good results in four (57 %) and three (43 %) patients, respectively. The remaining three patients had a shorter follow-up, but were fully mobile with no complications observed. DISCUSSION: It has been reported that bony union of acetabular fracture after open reduction and internal fixation (ORIF) was achieved in 74 % patients younger than 60 years, but in only 44 % of the patients older than 60 years. Secondary THA following ORIF is a demanding technique. Due to adhesions and a frequent malposition of the acetabulum, THA is associated with and increased risk of infection, tendency to develop para-articular ossifications, and a higher risk of early component loosening than in the standard procedure. One of the options is to perform acetabular stabilization and primary THA at one stage. The results of our study are fully in agreement with those reported for THA in hip arthritis or dislocated fracture of the femoral neck. CONCLUSIONS: Acute primary THA with the use of a antiprotrusion cage and bone grafting for acetabular fractures in elderly patients allows us to employ only one surgical technique for definitive repair. It provides primary stability and immediate pain relief, permits graded weight-bearing and early pain-free mobilization, and may also treat hip arthritis, if it exists. This technique has also good prospects for a selected group of younger patients in whom the treatment of acetabular fractures has a poor prognosis. Key words: acetabular fracture, elderly patient, primary total hip arthroplasty.

Determination of synthetic phenolic antioxidants in food by high-performance liquid chromatography.

This review deals with HPLC method to be used for the determination of synthetic phenolic antioxidants added to various foods. Sample preparation, isolation techniques, separation systems as well as detection methods used in applied food analysis procedures are discussed.

[Endoscopy of the lacrimal ducts]. / Endoskopie der Tränenwege.

UNLABELLED: The available picturing methods in the diagnosis of functional and mechanical stenosis of the lacrimal drainage system do not allow direct optical evaluation of the mucosa. With the help of dacryoendoscopy, for the first time there is the possibility of receiving a direct morphological picture of the tissue of the lacrimal drainage system. PATIENTS AND METHODS: In a clinical study in the period January to June 1996, 76 dacryoendoscopies were done before an operative intervention in the lacrimal drainage system to find out what information can be obtained with dacryoendoscopy and what use this extra information is. RESULTS: In all of the dacryoendoscopies performed, direct evaluation of the mucosa was possible. Normal findings could be clearly differentiated from mucosa of acute or chronical inflammatory processes. The choice of the operative strategy changed in part of the planned operations, although in 37 cases where the preoperative diagnosis was stenosis of the lacrimal sac, only in 26 cases was dacryocystorhinostomy performed. Dacryoendoscopy provides an additional means of guaranteeing the quality of operative procedures, e.g., after intubation. CONCLUSIONS: Dacryoendoscopy provides an important additional diagnostic possibility in the diagnosis of diseases of the lacrimal drainage system. Dacryoendoscopy offers the possibility of direct evaluation of the mucosa, the choice of operative strategy is checked and, if necessary, changed, and with the connection of an erbium YAG Laser there is minimal invasive surgery with the aim of rechannelization of the lacrimal drainage system.

[Indications and Application of a Standard and Long Gamma-nail.]. / Indikácie a pouzitie standardného a dlhého gamma-klinca.

An alternative treatment of fractures of the coxal femur side is a new implant - gamma-nail. Furthermore, we present the results of study of 77 patients, mainly women (71,4%) with an average on age of 65,5 years. In 52 percent, we found relevant instabilities (AO groups 31 - A2.2, A2.3 and A3.3). The modalities of treatment and mobilization are described, and the clinical and radiological results are presented. Mobilization was possible in 84,2% of these cases. The 6,5% of operative and postoperative complications we have to face, are described in detail. Key words: bone nails, femoral fractures, hip fractures.

[Ipsilateral fractures of the diaphysis and upper femur.]. / Ipsilaterálne zlomeniny diafýzy a horného konca stehnovej kosti.

Ipsilateral segmental fractures of the diaphysis and the upper end of the femur are relatively rare. They are encountered more frequently in patients with multiple injuries. The basic prerequisite of treatment is an early and accurate diagnosis which may prove difficult in particular in patients with multiple injuries. Conservative treatment is associated with a high incidence of complications, therefore the authors recommend urgent or early surgical stabilization of both fractures. As a rule the method of open reposition and stabilization by plates according to principles of the AO school with the known advantages and shortcomings of this method is used. The authors found intramedullary osteosynthesis by a combination of interlocking nailing and the use of screws useful in intracapsular fractures or else Ender's method in case of the localization of the proximal fracture in the trochanteric area. In both types of fractures new types of nails are useful (long Gamma nail, reconstruction nail of the second or third generation) which before now were not available. Key words: ipsilateral femoral fractures, surgical treatment.

Lowering of polycyclic aromatic hydrocarbons concentration in a liquid smoke flavour by sorption into polyethylene packaging.

The liquid smoke flavour UTP-1 was spiked with polycyclic aromatic hydrocarbons (PAHs) at a level of total concentration 45-6 micrograms/kg and filled into bottles made of low-density polyethylene. The concentration of PAHs was followed for 14 days. During this time the concentration of PAHs dropped roughly by two orders--from 45.6 micrograms/kg to 0.73 micrograms/kg, when an inverse dependence between PAHs concentration and time of storage was observed. As demonstrated in the experiment, the lowering of PAHs concentration in the liquid smoke flavour UTP-1 was due to the sorption of PAHs on packaging material, in which PAHs were found at the end of the experiment.

Influence of cooking on benzo(a)pyrene content in smoked sausages.

The changes in benzo(a)pyrene (BaP) content of smoked sausages were monitored during 1 h cooking. During this time, the BaP content decreased from 4·80 to 1·87 µg/kg. The maximum drop in BaP content was reached in the first 20 min of cooking. Two factors affected the course of BaP changes, viz. water-holding capacity and the fat content. After excluding these factors, there was a high correlation coefficient of 0·996 between time of cooking and BaP content, which confirmed an inverse relationship between the decrease in BaP content and time of cooking. The BaP decrease was directly proportional to the decrease of fat content during cooking, when the relatively high BaP content of 7·71 µg/kg was found in the cooked-out fat.