The Oxford II medial unicompartmental knee replacement. A minimum 10-year follow-up study

Background. The first clinical results from unicondylar knee arthroplasty (UKA), which was introduced in the early seventies, were non-conclusive. The development and modernization of unicompartmental implants (mobile bearing models, such as Oxford II), and also stricter qualification criteria for UKA brought about significant improvement in long term outcome. The aim of our study was to assess the long-term outcome of UKA using Oxford II implants, and also to verify the inclusion criteria. Material and methods. The authors present an analysis of long-term outcome in unicompartmental knee arthroplasty in 42 patients, qualified for treatment according to the criteria of Kozin and Scott, and also the designers of the implant. The follow-up assessment was performed a minimum of 10 years after surgery (11.2 years average). Results. The results were assessed using the 100-point HSS scale. Excellent results were achieved in 10 cases, good results in 22 cases, fair results in 6 cases, and poor results in 4 cases. The implant survival rate was 86%. There were some complications related to surgical error or lack of strict compliance with the qualification criteria. Conclusion. UKA late results are comparable to those achieved in TKA, given proper qualification. Also, this procedure can be considered as a definitive solution in older patients.     

Local experience with total hip replacement in dysplastic coxarthrosis

Background. The goal of our study was to assess the efficacy of total hip replacement in the treatment of dysplastic arthrosis of the hip. Material and methods. Between November 2001 and June 2003 we performed total hip replacement in 40 patients (46 hips). Arthritic deformations were classified according to Crowe's classification scheme and operated using a variety of techniques and prostheses. Outpatient examinations were performed every 6 weeks. Rehabilitation began 24 hours after surgery. Results. The average time of hospitalization was 14 days. According to Harris's scale, the average result was 35.4 before operation, 59.8 immediately after surgery, and 79.16 at 18 months post-operatively. The average difference between lower limbs was 3 cm before surgery and 1 cm post-operatively. The average range of flexion in the hip preoperatively was 36 degrees , 85 degrees post-operatively. All the patients suffered pain in the dysplastic hip before surgery; 4.4% patients still felt pain 12 months after surgery. In 2 cases there was loosening of the acetabular component of the prosthesis, which required revision surgery. In 3 cases there was dislocation of prosthesis. In 2 cases the implant was infected. In 1 case there was paresis of the femoral nerve. Thromboembolism occurred in 3 cases. Conclusions. In Crowe's first and second degree dysplastic arthrosis of the hip, a good outcome is obtained with standard stem prosthesis. A CDH stem should be used in stenosis of the intramedullary canal. Patients with dysplastic hips have better quality of life after total hip replacement.     

Relation of tissue displacement and strain to invasively determined right ventricular stroke volume

The role of echocardiography in the clinical assessment of right ventricular (RV) systolic function remains limited. Limited data exist on the potential use of newer techniques for RV function assessment. Conventional echocardiography and tissue Doppler echocardiography (TDE) were performed during right-sided cardiac catheterization in 46 patients. Thermodilution or the Fick-derived RV stroke volume indexed (RVSVI) indexed to body surface area was used as the reference standard. Univariate and multivariate regression analyses were used to test correlations between RVSVI and various echocardiographic and TDE-derived parameters. In a subset of 12 subjects, changes in echocardiographic and TDE variables to reduced afterload from intravenous epoprostenol were measured. TDE-derived RV tissue displacement and systolic strain best predicted the RVSVI (r = 0.63, p = 0.001; r = 0.48, p = 0.002, respectively). The prediction improved after adjustment for tricuspid regurgitation jet vena contracta width (r = 0.74, p < 0.0001; r = 0.60, p < 0.001, respectively). Assuming a RVSVI of > or =30 ml/m(2) as normal, a RV displacement cutoff of 15 mm yielded a sensitivity of 100% and a specificity of 41% for RV dysfunction, and an RV systolic strain cutoff of 20% yielded a sensitivity of 91% and a specificity of 63%. The percentage change of RV systolic displacement correlated well with the percentage change of RVSVI after epoprostenol infusion (r = 0.75, p < 0.001). In conclusion, TDE-derived RV displacement and strain closely correlate with RVSVI and appropriately track load-related changes in RV function. These new parameters may help provide the noninvasive, quantitative assessment of RV function.     

Depressed tumor necrosis factor alpha and interleukin-12p40 production by peripheral blood mononuclear cells of gastric cancer patients: association with IL-1R-associated kinase-1 protein expression and disease stage

Our study investigated the ability of peripheral blood mononuclear cells (PBMCs) isolated from patients with different clinical stages of gastric cancer to produce proinflammatory (tumor necrosis factor alpha [TNFalpha], interleukin 12p40 [IL-12p40] and interleukin 6 [IL-6]) and antiinflammatory (interleukin-10 [IL-10]) cytokines after stimulation with lipopolysaccharide (LPS) or tumor cells, and its correlation with IL-1R-associated kinase-1 (IRAK-1) protein expression. The data showed that TNF production by tumor cell-stimulated PBMCs obtained from patients with advanced gastric cancer was significantly depressed in comparison to the control group. The response to LPS was less affected. IL-12p40 production was depressed in all stages of disease, while the release of IL-10 and IL-6 remained unchanged. Depressed tumor cell-induced TNF and IL-12p40 production was associated with diminished IRAK-1 protein expression in PBMC. These findings may suggest that in advanced gastric cancer (at least in some cancer patients) diminished IRAK-1 protein expression may be a novel mechanism responsible for or facilitating downregulation of innate immune response to tumor cells.     

Allelic loss at TP53 is not related to p53 protein overexpression in primary human endometrial carcinomas

We examined loss of heterozygosity (LOH) at the TP53 gene in primary human endometrial carcinomas (EC), and investigated the relationship between allelic loss, p53 protein overexpression, pRb-1 pathway alterations and MIB-1 proliferative activity. Applying the non-isotopic PCR-RFLP/VNTR-silver staining techniques, we investigated TP53 LOH in 46 tumors at four polymorphic loci. Out of 42 informative carcinomas, LOH was found in 19% of the cases studied. In general, there was no significant relationship between LOH and the clinical and pathological variables of cancer, including patient age, clinical stage, histological grade or depth of myometrial invasion. Interestingly, none of 7 tumors associated with hyperplasia revealed allelic imbalance, whereas 8 of 27 (30%) tumors without hyperplasia exhibited LOH (p=0.312; Fisher's exact test). Overexpression of nuclear p53 was not correlated with allelic loss at TP53 (p=0.336, Fisher's exact test). It is worth pointing out that p53 immunoreactivity was significantly related to proliferative activity of cancer (R=0.42, p=0.0037; Spearman's rank correlation test). A tendency towards a poorer outcome was reported in EC patients displaying TP53 LOH during short-time follow-up (p=0.093; log-rank test). None of the tumors simultaneously showed LOH at TP53 and RB1 genes (R=-0.211, p=0.16; Spearman's rank correlation test). p16INK4A alterations (LOH and gene deletion) occurred concomitantly, with 3 tumors showing the TP53 allelic loss, whereas the cyclin D1/cdk4 complex was overexpressed in a case with TP53 LOH. Altogether, losses at TP53 were not associated with p53 nuclear overexpression, but may affect a subset of EC patients characterized by an unfavorable prognosis at short-time follow-up. Allelic loss at TP53 seems to arise independently of LOH at the RB1 gene in carcinomas of the uterine corpus in humans. Disruptions at p16INK4A and/or cdk4/cyclin D1 concomitantly occurring with TP53 LOH may participate in the development of a subset of endometrioid-type ECs.     

Polymorphisms of the DNA Mismatch Repair Gene <Emphasis Type="BoldItalic">HMSH2</Emphasis> in Breast Cancer Occurence and Progression

Summary The response of the cell to DNA damage and its ability to maintain genomic stability by DNA repair are crucial in preventing cancer initiation and progression. Therefore, polymorphism of DNA repair genes may affect the process of carcinogenesis. The importance of genetic variability of the components of mismatch repair (MMR) genes is well documented in colorectal cancer, but little is known about its role in breast cancer. hMSH2 is one of the crucial proteins of MMR. We performed a case-control study to test the association between two polymorphisms in the hMSH2 gene: an A → G transition at 127 position producing an Asn → Ser substitution at codon 127 (the Asn127Ser polymorphism) and a G → A transition at 1032 position resulting in a Gly → Asp change at codon 322 (the Gly322Asp polymorphism) and breast cancer risk and cancer progression. Genotypes were determined in DNA from peripheral blood lymphocytes of 150 breast cancer patients and 150 age-matched women (controls) by restriction fragment length polymorphism and allele-specific PCR. We did not observe any correlation between studied polymorphisms and breast cancer progression evaluated by node-metastasis, tumor size and Bloom-Richardson grading. A strong association between breast cancer occurrence and the Gly/Gly phenotype of the Gly322Asp polymorphism (odds ratio 8.39; 95% confidence interval 1.44–48.8) was found. Therefore, MMR may play a role in the breast carcinogenesis and the Gly322Asp polymorphism of the hMSH2 gene may be considered as a potential marker in breast cancer.     

The visual acuity impairment as the only sign of cerebral aneurysms--case report

Cerebral aneurysms are the most common reason of subarachnoid haemorrhage at the age of 50-60. Though the results of such haemorrhage are severe (high morbidity and mortality), it is quite often, the first noticeable sign of the problem. Previous symptoms i. e. headache, ophthalmic disturbances, temporary neurological symptoms are often passed over. The authors present the case of a young woman with cerebral aneurysms, in which the visual acuity impairment was the only symptom of the disease.     

Antibiotic resistance of conjunctival bacterial flora in children

PURPOSE: To evaluate conjunctival bacterial flora in children and its resistance to the most frequently antibiotics used by the ophthalmologists in Poland. MATERIAL AND METHODS: Bacterial conjuntival cultures obtained in 593 children without ocular infections. RESULTS AND CONCLUSIONS: Pathogenic bacterial isolates were identified in 26.3% children. Most frequently isolated were Gram-positive cocci (70.5%). Significant resistance of Gram-positive cocci to aminoglicosides (5% to 65%) was observed. Emerging resistance to fluoroquinolones, especially of coagulase-negative staphylococci (in 21%), was also observed.     

Changes in bacterial flora of conjunctival sac in patients prophylacticaly treated with antibiotic before cataract operation

PURPOSE: The aim of the study was to estimate changes in bacterial flora of conjunctival sac changes in patients prophylacticaly treated with different antibiotics (chloramphenicol, gentamycin, ofloxacin, norfloxacin) before cataract operation. MATERIAL AND METHODS: The studied group consisted of 166 patients hospitalized for cataract surgery. The control group consisted of 33 persons, neither treated topically with antimicrobial drugs nor suffering from infectious or inflammatory diseases. On the first day and on the operation day conjunctival swabs were obtained and typical microbiological diagnosis was performed. During hospitalization only one antimicrobial drug was administrated topically (chloramphenicol, gentamycin, ofloxacin or norfloxacin) in the studied group. RESULTS: Prophylaxis with antibiotics before cataract surgery changes bacterial flora of conjunctival sac: quantitative changes were observed most frequently, but also hospital antibiotic resistant strains were detected. None of tested antibiotics caused total elimination of conjunctival flora in all patients. CONCLUSIONS: None of the antibiotics used in our study could cause total elimination of conjunctival flora. According to our results, the most effective antibiotics in prophylaxis before eye surgery are fluoroquinolones. Some patients before eye surgery have the pathogenetic conjunctival flora not causing the disease, yet increasing the risk of postoperative endophthalmitis.