Dynastab S: A new concept for high energy fractures of the distal tibia

Background. High energy fractures of the distal tibia ("pylon fractures") usually result in severe reduction of the range of motion of the superior ankle joint. If there is severe soft tissue trauma coexisting with the fractures, the possibilities for surgical treatment are limited. Our study examined the suitability of the DYNASTAB S external fixator (for ankle joint stabilization). Material and methods. We studied 25 adult patients (15 men, 10 women), treated from April 2001 to March 2003, to whom the DYNASTAB-S stabilizer was applied for an average of 10.5 weeks. Results. In all patients bone union was achieved, with a good range of motion in the talo-crural joint. All patients tolerated the applied treatment well. The average hospital stay was 9 days. There were 2 cases of transient inflammatory reaction of the skin around the screws, and 1 case of algodystrophy syndrome, which resolved after physical treatment combined with pharmacotherapy. Conclusions. The Dynastab S external fixator is very successful in the treatment of fractures with poor prognosis in traditional methods of conservative and surgical treatment, providing bone union and good functional efficiency of the superior ankle joint. The use of the mechanical joint imitating the movement of the injured ankle joint allows for early joint rehabilitation without loss of stability of the fracture. Adaptation of the device to the operated limb is excellent. The Dynastab S external fixator can be recommended for wider use in the treatment of pylon fractures.     

Transcervical-subxiphoid-videothoracoscopic "maximal" thymectomy--operative technique and early results

Background

The operative technique of a transcervical-subxiphoid-videothoracoscopic “maximal” thymectomy without sternotomy is described and the early results of the follow-up of patients operated on are analyzed.

Methods

One-hundred “maximal” transcervical-subxiphoid-videothoracoscopic thymectomies were performed for nonthymomatous myasthenia gravis during a recent 32-month period (from September 1, 2000 to May 8, 2003). Patient characteristics, complications, pathologic findings, and the results of follow-up were analyzed.

Results

The study group included 83 women and 17 men. The mean age was 29.8 years (range, 10-69 years). The mean preoperative duration of myasthenia was 2.73 years (range, 3 months to 17 years). The preoperative Osserman score was I-III, 27 patients were taking steroids preoperatively. Eleven operations were performed by two teams working simultaneously and 89 operations were performed by one surgeon including four combined thymectomy-thyroid operations in patients with myasthenia and thyroid nodules. The mean operative time for two-team approach thymectomies was 159.09 minutes (range, 140-170 minutes) and the mean operative time for the thymectomy performed by one surgeon was 199.41 minutes (range, 150-270 minutes) (p = 0.0004). There was a 15.0% (15 out of 100) postoperative morbidity and no mortality. Foci of ectopic thymic tissue were found in 71.0% of the patients and were most prevalent in the perithymic fat (37.0%) and in the aorta-pulmonary window (33.0%). The mean weight of the specimen was 78.4 g (range, 14.5-253.0 g). In 48 patients followed-up for 12 months, the improvement rate was 83.3%, the no improvement rate was 14.6%, and 1 patient died during the follow-up period. Complete remission rates were 18.8% and 32.0% after 1 and 2 years of follow-up, respectively.

Conclusions

We conclude that the “maximal” transcervical-subxiphoid-videothoracoscopic thymectomy is a safe operative technique, avoiding a sternotomy, performed partly in an open fashion with the extensiveness comparable with the transsternal extended and “maximal” thymectomies. The two-team approach helps to reduce the operative time. However, because of the limited time of follow-up it is too early for the final assessment of the long-term results of this method in the treatment of myasthenia gravis.     

Comparison of PCR and ELISA techniques in the diagnosis of Mycoplasma pneumoniae airway infections in children

Mycoplasma pneumoniae (Mycoplasma pn.) is a common airway pathogen in childhood. Mycoplasma pn. infections appear as epidemics (every 3-7 years) and are very often the cause of community--acquired pneumonia among people being in close contact for longer period of time and specially in children, young adults and elderly. For many years, routine diagnosis of Mycoplasma infections based upon ELISA methods, which determine a level of specific Mycoplasma antibodies in class G, M, A in serum. One of the most reliable new diagnostic technique is PCR, which determines Mycoplasma pn. DNA in clinical samples. The aim of the present study was to compare PCR and ELISA techniques in the diagnosis of Mycoplasma pn. airway infections in children. Sixty two children aged 2-17 years, with symptoms of Mycoplasma pn., infection, with presence of IgM, or/and IgG against Mycoplasma pn. in serum took part in the study. All children had antibodies against Mycoplasma pn. measured by ELISA method and Mycoplasma pn. DNA in PCR. The results showed high similarity between both methods (ELISA and PCR) in samples from swab throat.     

Nicotinic acetylcholine receptor immunohistochemistry in Alzheimer's disease and dementia with Lewy bodies: differential neuronal and astroglial pathology

Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) are common forms of dementia in the elderly. The neuropathology of AD and DLB is related to cholinergic dysfunctions, and both alpha4 and alpha7 nicotinic acetylcholine receptor (nAChR) subunits are decreased in several brain areas in both diseases. In this immunohistochemical study, we compared neuronal and astroglial alpha4 and alpha7 subunits in AD, DLB and age-matched controls in the hippocampal formation. The numbers of alpha4 reactive neurons were decreased in layer 3 of the entorhinal cortex of AD and DLB, whereas those of alpha7 reactive neurons were decreased in layer 2 of the subiculum of AD and DLB and in layer 3 of the entorhinal cortex of DLB. In contrast, the intensity of alpha7 reactive neuropil was significantly higher in AD than in controls or DLB in a number of areas of the hippocampus (CA3/4 and stratum granulosum), subiculum and entorhinal cortex. An increase in alpha7 immunoreactivity in AD was also associated with astrocytes. The number of astrocytes double-labelled with alpha7 and glial fibrillary acidic protein (GFAP) antibodies was increased in most areas of the hippocampus and entorhinal cortex in AD compared with controls and DLB. Increased astrocyte alpha7 nAChRs in AD may be associated with inflammatory mechanisms related to degenerative processes specific to this disease.     

The central action of botulinum toxin type A assessed by brain auditory and somatosensory evoked potentials

BACKGROUND AND PURPOSE: Botulinum toxin type A (BTX-A) acts as a neuromuscular blocker in the release of acetylcholine. Nevertheless, some clinical effects and side effects are difficult to explain only due to the peripheral mode of action. The aim of the study was to assess the central effects of BTX-A by measuring the two modalities of evoked potentials (somatosensory and brain-stem auditory). MATERIAL AND METHODS: In 23 patients (13 females, 10 males, mean age of 46, range of 25-71) with idiopathic cervical dystonia (never treated with BTX-A) brainstem auditory evoked responses (BAER) and somatosensory evoked potentials from upper extremities (SEP) were performed before and 4-6 weeks after BTX-A administration. BTX-A (Botox in 14 patients, Dysport in 9 patients) was injected into neck muscles: sternocleidomastoideus, splenius capitis, trapezius and levator scapulae. RESULTS: The authors did not find any statistically significant differences in basic parameters (latency and interlatency of I, III, V in BAER and N9, N13, N20 and P25 responses in SEP) before and after BTX-A administration. CONCLUSIONS: It seems that BTX-A does not have any direct central effect or the methods are not sensitive enough to detect them. Remote (anatomically distant) clinical effects seen by other authors or side effects may be explained by indirect mechanism due to deafferentation of stimuli from muscle spindles after BTX-A injection and thus modifying the central loops of reflexes or due to unpredictable hematogenous spread of BTX-A to distant muscles.     

Comparison of two groups of patients with serous and mucinous types of borderline ovarian tumors

OBJECTIVE: The retrospective comparison of two groups of patients with the most common types of borderline ovarian tumors (BTO): serous and mucinous. METHODS: All patients were treated between 1978 and 2000 at the 2nd Department of Obstetrics and Gynecology Medical University of Gdańsk. The first group consisted of 58 patients with serous BTO. The second group consisted of 48 patients with mucinous BTO. These groups were compared according to such parameters: age at diagnosis, parity, clinical symptoms, localization of tumor, tumor size, type of operation, stage of disease, utilization of adjuvant therapy, presence of recurrence and 5-year survival. Statistical comparisons were made by the chi 2 test. The clinical life table analysis was performed to determine 5-year survival and comparisons were made by means of the Long Rank tests. RESULTS: The mean age of serous BTO was 53.1 +/- 12.8 and of mucinous BTO 43.3 +/- 17.9 (p = 0.0000). In the first group 15.5% and in the second 43.8% women were nullipara (p = 0.0602). The main symptom of serous BTO was pain--53.5% patients and that of mucinous BTO increasing girth--47.9% patients (p = 0.0456). The mean size of serous BTO was 13.7 +/- 6.9 cm and that of mucinous BTO was 20.3 +/- 9.5 cm (p = 0.004). 43 patients (89.6%) with mucinous and 28 patients (48.3%) with serous BTO were at I A stage and 9 patients (15.5%) with serous and only one (2.1%) with mucinous were at III stage (p = 0.0008). The mucinous BTO--affected were more frequently treated conservatively than serous BTO--ones which were rather treated radically with using adjuvant therapy (p = 0.003). Residual disease was observed mainly in patients with serous BTO. 5-years survival was better in patients with mucinous BTO, 87.7% and 85.2% respectively (p = 0.0001). CONCLUSIONS: 1. The mucinous BTO occurred more frequently than serous BTO in women of the childbearing age. 2. The extraovarian disease was observed more often with serous BTO than the mucinous BTO. 3. The mucinous BTO was usually bigger than serous BTO and mainly affected only one ovary. 4. The mucinous BTO was more frequently treated conservatively than serous BTO which were rather treated radically with use of adjuvant therapy. 5. The recurrence rate was higher and the 5-year survival was worse in patients with serous BTO.     

Sonoangiography and logistic regression analysis in the preoperative differentiation of ovarian tumors

OBJECTIVE: To apply logistic regression analysis for several clinical and sonographic data for the construction of a predictive model that could be helpful in the preoperative differentiation of adnexal masses. MATERIALS AND METHODS: Two hundred and eight women with tumors thought to be of adnexal origin were examined preoperatively. Initial analysis included age and menopausal status, ultrasound derived morphological features of adnexal masses (unilateral/bilateral tumors, papillae, septae, tumor size and volume) as well as color Doppler criteria such as PI, RI, Peak Systolic Velocity, PSV assessment. In all examinations we used B&K 2002 ADI (Denmark) and Kretz Voluson V730 (Austria) scanners with transvaginal probes 5-9 MHz. Stepwise logistic regression analysis was used to construct a predictive model that would allow probability of malignancy calculation for individual patient. RESULTS: There were 159 benign and 49 malignant masses. Seven cancers were in FIGO stage one. Statistical analysis revealed that only 5 of initially tested 14 variables had significant influence on the regression equation. These were: age, bilateral mass, presence of septa > 3 mm, papillary projections > 3 mm in the tumor wall and subjective color scale assessment according to Timmerman et al. (1999). Sensitivity and specificity at the 50% probability level of malignancy in the studied tumor were 77.5% and 96.8%, respectively. When 25% cut-off probability level was used, sensitivity increased to 87.7% and specificity dropped to 89.9%. Prospective testing in a new group of 30 patients (5 ovarian cancers) gave sensitivity of 80% and specificity of 100%. CONCLUSIONS: The use of logistic regression analysis can help in modeling clinical and sonographic data. Our model had better predictive value than individual tests and allowed to calculate true probability figure of ovarian malignancy for any given patient with adnexal mass.     

Gastrointestinal surgery in patients with ovarian cancer

OBJECTIVES: The objectives were to assess indications as well as outcome and morbidity of gastrointestinal surgery in patients with ovarian cancer. METHODS: The study included 74 patients with primary ovarian cancer who had debulking surgery (bowel surgery) from 1987 to 2001. RESULTS: In our group postoperative residual tumor was--R0 in 15 cases (20.3%) and < or = 2 cm (R2) in 33 patients (44.6%). CONCLUSION: Gastrointestinal surgery is frequently indicated during operation in ovarian cancer. Gynecologic cancer surgeons should be trained accordingly.