Modified algorithm in treatment of patients with chronic low back pain with neuroradiological diagnostic techniques]

The most difficult in proper qualification of the patient with chronic low back pain for an operative treatment is determination of the chance for satisfactory result. The diversity of the pain eliciting structure in the spine influence the decision. In the paper we have analyzed patient where the operative treatment was considered. In 149 patients divided in two groups the (not being previously operated on the spine--group 1 and after spine surgery--group 2) the neuroradiological procedures were performed (sacral epidural block, facet injections, root injections of the lumbar spine). As the result of this procedure in 108 patients (72%) surgical intervention at that time was abandoned. Conclusion. In our opinion the neuroradiological diagnostic procedures should be mandatory in back pain management of the patient were operative treatment is considered. We present the modified algorithm in diagnostic procedure preceding the operation.     

Avantage double mobility press--fit cup in total hip arthroplasty]

The Avantage double mobility press-fit cup was devised by Dr. Bousquet in the 70's to bring reasonable response to a problem of recurrent dislocation after total hip arthroplasty. The cup is attached to the femoral head by a bipolar polyethylene liner. The polyethylene liner moves freely inside a shiny--polished metal cup. The angular range of motion before impingement is increased by the mobility of the liner. The double connection (cup-liner, liner-head) reduces the stress on the metal cup and improve the stability of the prosthesis. The solution has proved to be efficient in reducing dislocation risk and maintains at the same time the appropriate range of motion. Between January 2004 and November 2005, 113 hip arthroplasties in 108 women with use of the double mobility cup were performed. The cemented version of the Avantage cup was inserted in 15 patients (mean age--76.9 years). Uncemented, HA coated implant was used in 98 patients (with mean age of 55 years). The mean follow-up was 20.4 months. No one patient was lost to follow-up. No postoperative dislocation was observed during follow-up. There was no unwanted leg lengthening greater than 1 cm. The Avantage cup may be indicated in any primary total hip arthroplasty especially in those with increased risk of postoperative dislocations. This cup enables a correct balance of the hip without a need of the unwanted lengthening of the leg.     

Injections of botulinum A toxin for the treatment of anal fissures.

OBJECTIVE: To find out how injections of botulinum A toxin influence the healing of anal fissures. DESIGN: Retrospective study. SETTING: Medical University of Lodz, Poland. SUBJECTS: 13 patients (6 women, 7 men), mean age 49 (range 31-78), treated with injections of botulinum A toxin 50 units on either side of the anal fissure into the internal anal sphincter from May to December 1999. MAIN OUTCOME MEASURES: Complications and relapse. RESULTS: Seven fissures had healed by one month and four by two months. Two remained unhealed but asymptomatic. There was no incontinence of flatus or faeces after three months of treatment. Resting anal pressure was significantly lower in 10 of 13 patients compared with before treatment (p < 0.05). One fissure relapsed after 4 months and this patient had a successful anal stretch. CONCLUSION: Injection of botulinum A toxin gives good results in the treatment of anal fissures.     

Five-Year Follow-up of a Randomized Clinical Trial of Unilateral Thyroid Lobectomy with or Without Postoperative Levothyroxine Treatment

Background  

The aim of this study was to compare the prevalence of recurrent nodular goiter in the contralateral thyroid lobe among patients after unilateral thyroid lobectomy for unilateral multinodular goiter (MNG) receiving versus not receiving postoperative prophylactic levothyroxine (LT4) treatment.     

Novel mutation in the ligand-binding domain of the androgen receptor gene (l790p) associated with complete androgen insensitivity syndrome.

Mutations in the X-linked androgen receptor (AR) gene cause androgen insensitivity syndrome (AIS), resulting in an impaired embryonic sex differentiation in 46,XY genetic men. Complete androgen insensitivity (CAIS) produces a female external phenotype, whereas cases with partial androgen insensitivity (PAIS) have various ambiguities of the genitalia. Mild androgen insensitivity (MAIS) is characterized by undermasculinization and gynecomastia. Here we describe a 2-month-old 46,XY female patient, with all of the characteristics of CAIS. Defects in testosterone (T) and dihydrotestosterone (DHT) synthesis were excluded. Sequencing of the AR gene showed the presence in exon 6 of a T to C transition in the second base of codon 790, nucleotide position 2369, causing a novel missense Leu790Pro mutation in the ligand-binding domain of the AR protein. The identification of a novel AR mutation in a girl with CAIS provides significant information due to the importance of missense mutations in the ligand-binding domain of the AR, which are able to induce functional abnormalities in the androgen binding capability, stabilization of active conformation, or interaction with coactivators.     

Middle ear schwannoma--case report

Schwannoma is one of the common benign middle ear space tumors. The tumors may present with facial nerve paresis or palsy, otologic symptoms and/or parotid mass middle ear schwannomas may originate from the nerves of the tympanic caviti or by extensions from outside the middle ear space. Schwannomas of the facial nerve can occur along any segment, but they frequently involve the geniculate ganglion and extend proximally or distally from there. MRI and CT imaging characteristics are similar to those of vestibular schwannomas. We present the clinical and radiologic features of a middle-space schwannoma originating from facial nerve. The patient underwent middle ear exploration and mastoidectomy. The tumor was of facial nerve origin and was separated from middle ear. The pathologic diagnosis was schwannoma.     

Environmental monitoring and control strategy of urban mosquito Culicidae (Diptera: Culicidae) populations in Wrocław

Among dipterans of medical and veterinary importance, the mosquitoes (Culicidae) play the most important role both as vectors and nuisance insects. Mass occurrence of floodwater mosquito species in the flooded area in Wroc?aw district (Lower Silesia, Poland) in 1997 has enhanced the already existed problem of mosquito control. A successful model of control strategy for the city based on the currently recommended integrated methodologies with special emphasis on preventive treatment of aquatic larvae with microbial insecticides has been conducted. Bacillus thuringiensis israelensis-based formulations replaced chemicals to control Culex pipiens and Culiseta annulata--two dominant species out of eight noticed during field study in Wroc?aw area in the years 1998-2000. Use of Bti larvicide or other biocontrol agent, conserving biodiversity, requires collecting entomological data, mapping and treating all breeding sources as well as the designing appropriate strategies every year.     

Prevalence of Toxoplasma gondii infection in cats from Olsztyn city

17 serum samples from cats after surgery operations in one of veterinary clinic in Olsztyn have been examined. The study on anti-Toxoplasma gondii immunoglobulin IgG presence was carried out by direct agglutination method using the Toxo-Screen DA test. 70.6% positive samples in 1:40 titration, 58.8% in 1:4000 titration and 5.9% questionable result in both dilutions were obtained.