Charcot's arthropathy of the hip joints: a late manifestation of tabes dorsalis successfully treated by total joint arthroplasty. report of 2 cases

This article describes 2 cases of Charcot's arthropathy of the hip joints successfully treated with cemented total hip arthroplasty. Follow-up at 10 and 9.5 years confirmed the success of the treatment. This article also includes a review of current publications on the topic.     

Interosseous ligaments and TFCC lesions in intraarticular distal radius fractures - radiographic versus arthroscopic evaluation

Background. Intraarticular distal radius fractures are marked by a significant amount of soft tissue damage, which is not always noticed on routine X-rays. The lack of early diagnosis and treatment of these lesions can lead to the development of carpal instability, and subsequently to limited range of motion or wrist pain syndrome. The purpose of this article is to show how these lesions can be diagnosed arthroscopically, and at the same time to compare arthroscopic evaluation to standard X-rays. Material and methods. In the period from August 2004 to April 2005 we performed 21 wrist arthroscopies in 20 patients with intraarticular distal radius fractures (7 women and 13 men, ranging in age from 20 to 63 years, average age 38). Results. In all these patients, numerous soft tissue lesions were found during arthroscopic examination: TFCC lesions in 13 patients, SL ligament lesions in 7 patients, and an LT ligament lesion in 1 case. None of these lesions were visible in X-rays. An ulnar styloid fracture was found in 9 cases, in 4 cases associated with TFCC lesions. Loose bodies, not seen in previous X-rays, were detected in 8 patients. Conclusions. Arthroscopy in intraarticular distal radius fractures facilitates the diagnosis and treatment of soft tissue lesions, which are numerous and usually not detected on standard X-rays.     

Correlation between centralization or peripheralization of symptoms in low back pain and the results of magnetic resonance imaging

Background. One of the main reasons for low back pain is displacement of the nucleus pulposus within the intervertebral disc and spinal canal. In the diagnosis of low back pain a clinical examination is essential, supplemented by magnetic resonance imaging (MRI). The main purpose of our research was to demonstrate that the results of a functional diagnosis based on the McKenzie protocol, when compared to abnormalities found in MRI, allow for more efficient management of conservative therapy. Material and methods. Our clinical material consisted of 98 patients, divided into 2 groups according to whether the symptoms observed were centralized (group A) or peripheralized (group B). The results of the clinical examination was compared with MRI examinations. Results. In order to assess treatment effectiveness and prognosis in low back pain with MRI findings, a precise analysis was done. Three groups were distinguished: 49 patients had herniation and extrusion of the nucleus pulpous, but the annulus fibrosus and the fluid reserve were intact; 46 patients had extrusions or sequestrations, along with stenosis of the spinal canal; 3 patients had no pressure on the nerve roots. Conclusion. Centralization usually implied that the annulus fibrosus would be intact in MRI examination. In these cases the MRI revealed herniations. Centralization also occurred in cases of extrusions where the spinal canal was wide, and the liquid reserve was preserved. Peripheralization occurred in cases of sequestration and extrusions when there was stenosis of the spinal canal.liquid reserve was preserved. 2. Peripheralisation occurred in the cases of sequestration and extrusions when spinal canal was narrow.     

A systematic review of Helicobacter pylori eradication treatment schedules in children

SUMMARY Methods We systematically reviewed all available data in the paediatric literature on treatment for Helicobacter pylori infection to determine overall efficacy of different schedules. A comprehensive search of all published articles and letters from 1987, and of abstracts presented at three main meetings on this topic between 1997 and 1999, was carried out. Results from all English and French papers, letters and abstracts were extracted and analysed. Results Only 30 full articles and 16 abstracts were found, with results on eradication of H. pylori in 870 and 1552 children, respectively. Monotherapy or dual therapy with an antisecretory drug plus one antibiotic showed a very low efficacy. Dual therapies with bismuth plus one antibiotic (either amoxycillin or a nitro‐ imidazole) or two antibiotics when administered for 2 or more weeks were as effective as either bismuth‐based or proton pump inhibitor‐based triple therapies. Triple therapies were less effective than in adults, and while bismuth‐based triple therapies were more effective when given for 2 weeks than for one week, proton pump inhibitor‐based triple therapies have a similar efficacy irrespective of the duration. Conclusion In children dual therapies seemed as effective as triple therapies, and longer courses of proton pump inhibitor‐base triple therapies are not better than shorter ones.     

Measurement of postprandial changes in urine acid output to detect changes of gastric acid secretion after proton pump inhibitors in children

Acid inhibition after proton pump inhibitors in children is variable, and to measure it by a noninvasive method may help to tailor treatment. To study gastric acid inhibition after a single dose of PPI, by measuring urinary acid output (UAO), which decreases as parietal cells release acid into the stomach during a meal, we performed a prolonged pH monitoring in 31 children (age range 3–16 yrs). Esophageal and intragastric pH was recorded for 24 hr and for 5 more hr after a single dose of PPI or placebo. Urine was collected early in the morning, and 1 hr after a test meal. Intragastric and urinary parameters were analyzed for 5 hr after PPI and compared to the same 5 hr at baseline. After PPI, median gastric pH significantly increased, and median UAO became significantly smaller (–0.31 vs. –1.40 at baseline; P = 0.002) but was unchanged after placebo. Inhibition of gastric acid induced by PPI can be detected by changes in UAO and its determination may be useful to monitor the PPI effect.     

A systematic review of Helicobacter pylori eradication treatment schedules in children

SUMMARY
Methods   We systematically reviewed all available data in the paediatric literature on treatment for Helicobacter pylori infection to determine overall efficacy of different schedules. A comprehensive search of all published articles and letters from 1987, and of abstracts presented at three main meetings on this topic between 1997 and 1999, was carried out. Results from all English and French papers, letters and abstracts were extracted and analysed.
Results   Only 30 full articles and 16 abstracts were found, with results on eradication of H. pylori in 870 and 1552 children, respectively. Monotherapy or dual therapy with an antisecretory drug plus one antibiotic showed a very low efficacy. Dual therapies with bismuth plus one antibiotic (either amoxycillin or a nitro- imidazole) or two antibiotics when administered for 2 or more weeks were as effective as either bismuth-based or proton pump inhibitor-based triple therapies. Triple therapies were less effective than in adults, and while bismuth-based triple therapies were more effective when given for 2 weeks than for one week, proton pump inhibitor-based triple therapies have a similar efficacy irrespective of the duration.
Conclusion   In children dual therapies seemed as effective as triple therapies, and longer courses of proton pump inhibitor-base triple therapies are not better than shorter ones.     

Methods of clinical evaulations and scales of assessment of the cervical and lumbar disc disaease based on the Oswestry scale

Methods of examination used in scientific work are different. They consist of retrospective, prospective and specific randomised surveys. Long term results obtained in conducted studies should be compared with results published in literature.
In order to unify different criteria used in back pain, authors decided to analyse the most frequently used scales. Data obtained form literature allowed to assume an attitude to accepted criteria of evaluation. Among different methods the most frequently used is the Oswestry scale, which estimates a degree of disability of patients with low back pain and cervical pain very precisely. This scale was proposed on the 14th Symposium of Spine Surgery Section in Miedzeszyn - Otwock, in order to unify and compare long term results of lumbar and cervical pain.     

Problems, progress, and late outcome from the treatment of septic loosening of hip arthroplasty

Background. The goal of this research was to evaluate problems and progress in the treatment of septic loosening of total hip replacements. These complications are typically the result of unfamiliarity with the risk factors, technical errors during surgery, improper management by physicians, or other factors, sometimes difficult to ascertain. The bacteria which cause injections are identified, and the methods used to control and manage infections are described.
Material. The authors studied complicating infections in hip prostheses in 129 patients. This clinical material was divided into two groups: 31 patients with early infections and no indications of prosthesis loosening were assigned to Group I, while Group II included 98 patients with symptoms of late infection and signs of endoprosthesis loosening. Surgical treatment of early infection involved thorough debridement of the focus and many weeks of antibiotic therapy, both local and systemic.
Results. In 21 cases complete healing was obtained. Due to recurrence of the infection, removal of the endoprosthesis was necessary in 10 cases. For the 98 patients with late infection, healing of the infection was noted in75 joints (76%) following removal of the focus of injection along with the endoprosthesis and cement. Poor outcome as measured by pain and persistent fistulae, was obtained in 11 joints (11,5%). Only in 12 patients (12,5%) was the endoprosthesis implanted without recurrence of the infection, obtaining, a good treatment outcome.
Conclusions. The basic factors reducing the risk of causing septic loosening of the endoprosthesis are familiarity with the risk factors, the proper antibiotic prevention, the command of the requiste surgical skill and a high level of asepsis in the operating theater. The most commonly observed final outcome of treatment of the sequelae of septic loosening of the prosthesis is unstable pendent hip. Repeat implantation of an endoprosthesis can be considered in younger patient when healing of the infection has been confirmed clinically and biochemically.     

Cytotoxic activity of gemcitabine,alone or in combination with mitotane,in adrenocortical carcinoma cell lines

We aimed at investigating in vitro the cytotoxic activity (determined using WST-1, apoptosis and cell cycle assays) of gemcitabine, alone or in combination with mitotane, in mitotane-sensitive H295R and mitotane-insensitive SW-13 cells. Results of these experiments were compared with drug-induced modulation of RRM1 gene, the specific target of gemcitabine. In H295R cells, mitotane and gemcitabine combinations showed antagonistic effects and interfered with the gemcitabine-mediated inhibition of the S phase of the cell cycle. By contrast, in SW-13 cells, except when mitotane was sequentially administered prior to gemcitabine, the combination of the two drugs was synergistic. Such opposite effects were associated with opposite expression profiles of the target gene, with significant up-modulation in H295R but not in SW-13 under gemcitabine and mitotane combination treatment.     

Transient Peripartum Osteoporosis of the Femoral Head in First and Third Pregnancy

The aim of this article was to present transient peripartum femoral head osteoporosis. This very rare condition occurred twice in our patient—a woman in her 30s. The cases described in the literature were mostly unilateral, with bilateral hip involvement noted much less frequently. In our patient, transient osteoporosis occurred in the third trimester of her first pregnancy in the right hip, her second pregnancy was uncomplicated, and in the third trimester of the patient's third pregnancy, osteoporotic changes were noted in the left hip joint. The patient breastfed her first and third babies only 3 wk each. She breastfed her second baby for 4 mo. The diagnostic workup was based on the clinical examination and radiographic/magnetic resonance imaging, which revealed bone marrow edema, and the dual-energy X-ray absorptiometry scans. The treatment consisted in core decompression of the femoral head (foragé), unloading of the hip using crutches as well as administration of calcitonin and calcium supplements. Complete recovery of the femoral heads was achieved. The follow-up time was 7 yr.