Endoscopic transsphenoidal treatment of empty sella turcica syndrome using a silastic coil.

An empty sella turcica is due to the presence of an arachnoid diverticulum with its fluid content in the sella turcica, exerting pressure on the pituitary gland. In most cases this condition has an asymptomatic course, and is discovered by accident. Some patients, however, develop empty sella turcica syndrome with headaches, mild dishormonose, dysopsia and, rarely, spontaneous rhinorrhoea. Surgical treatment of empty sella turcica consists of filling the sella, through the transsphenoid route, with tissues collected from the patient or with artificial material. The aim of this report is to present our own experience of endoscopic extradural sella elevation using a silicone spiral, in 4 patients with primary empty sella turcica syndrome. The main indication for surgery was progressing dysopsia. The microinvasive endoscopic transsphenoidal method has been used, based upon the Jho technique with our own modifications. For the elevation of the sella, we used a coiled section of a Pudenz valve intraventricular silicone drain, adjusting its size to the dimensions of the operated sella. Both the implantation of the helix, and the postoperative course were uncomplicated for all surgically treated patients. The follow-up of several months confirmed improvement of the dysopsia in all surgically treated patients. MR examinations confirmed the correct location of the silicone spiral placed in the sella. It seems that the good results achieved are due to a correct indication for surgical treatment. The follow-up period ranges from 12 to 30 months and, so far, the clinical improvement is stable and satisfying both for the patients who underwent treatment and for the neurosurgeons.

Hydrogel dressings in the treatment of wounds with skin defect complications.

Background. The purpose of the present study was to compare the performance of the Hydrogel dressing with that of traditional dressings in the treatment of wounds with skin defects.
Material and methods. 32 patients with traumatic skin defects were included in the study. 16 were treated with Hydrogel dressings, and 16 with traditional dressings. We compared the time required for complete epithelialization and the level of pain experienced on removal.
Results. The trial dressing demonstrated faster healing time (ave. 5-6 days faster). The patients from the experimental group experienced less during dressing changes.
Conclusions. We found that dressings demonstrated significantly faster epithelialization time in comparison with traditional wound dressings. The application of Hydrogel dressings enhanced patient comfort.

[Current methods of thromboprophylaxis in total hip arthroplasty]. / Wspólczesne metody profilaktyki przeciwzakrzepowej w alloplastykach calkowitych stawów biodrowych.

The paper presents a review of methods of thromboprophylaxis, with regard given to both pharmacological and physiotherapeutic means in patients who underwent a total hip replacement procedure. Routine procedure should involve proper assertion of indications for surgical treatment, appropriate preoperative planning, surgery carried out in conduction anaesthesia, in the shortest possible time and as atraumatically as possible. Several weeks' of pharmacological treatment involving use of low molecular weight heparins in unison with mechanical means e.g. elastic stockings should follow surgical intervention. Quick mobilization of the patient following the surgical procedure along with intensive physiotherapy results in a decrease of the risk of thrombosis. In order to increase the efficiency of thromboprophylaxis different preventive methods should be applied simultaneously.

[Surgical stabilization of fractures and dislocations of the spine]. / Operacyjna stabilizacja kregoslupa w leczeniu zlaman i zwichniec.

Observing the results of surgical treatment in 84 patients (64 males and 20 females) it was noted that stability of the cervical spine with a damaged posterior column could be achieved by using a coticospongious graft wedged in between the vertebral bodies. Unstable fractures of the thoracaic, thoracolumbar, and lumbar spine are best treated with a transpedicular stabilization system, involving application of either rods or plates onto the vertebral bodies. When using transpedicular screws, stability is achieved when screws are of the right size, are properly implanted into the pedicles and the rods are linked by transverse connectors (forming a 3D construction). Reconstruction of the anterior column by using bone graft or titanium baskets is of crucial importance.

An atypical surgical solution in a hangman's fracture: case report.

Anyone who is familiar with the pathomechanism of hangman's fractures will surely think twice before considering this type of injury to be relatively safe, on the grounds that a fracture of the C2 arches creates the conditions for decompressing the spinal cord, while the fact that the entire posterior complex is maintaining the ligament connection means that the fracture is relatively stable. Doe to the complexity of the pathomechanism involved in fractures, it is difficult to set the displacement non-surgically, and it may be dangerous to do so in the event of uncontrolled spine distraction. This article describes the surgical solution used to treat patient with a hangman's fracture using the anterior and posterior approaches simultaneously. The surgical procedure described here made it possible to decompress the spinal cord, perform a solid fixation, mobilize the patient quickly after surgery, and initiate effective rehabilitation.

[Factors influencing bone mineral density around the femoral stem after cementless total hip arthroplasty]. / Wybrane czynniki wplywajace na gestosc mineralna kosci wokól trzpienia endoprotezy po bezcementowej alloplastyce stawu biodrowego.

Factors influencing bone mineral density around the femoral stem after PM cementless total hip arthroplasty were evaluated in longitudinal study of 18 hips in 18 patients who had undergone surgery due to unilateral hip osteoarthritis. Bone mineral density in the femoral neck was determined by dualenergy X-ray absorptiometry measurement performed preoperatively and in periprosthetic femoral Gruen's zones prospectively 2 weeks, 3, 6, 12 and 24 months after surgery. The concentrations of calcium, magnesium and fluoride were measured in cortical and trabecular bone samples taken from resected femoral head and neck. At 12 and 24 months after the operation the regional bone mineral density measurement showed significant, maximum decrease but after 12 months bone mineral density appeared to be stabilized. The analysis of preoperative femoral neck density and fluoride content in trabecular bone proved that osteopenia and lower fluoride concentrations correlated significantly with greater bone density decrease after total hip arthroplasty. No other factors (age, sex, weight, calcium and magnesium concentrations in bone and fluoride concentration in cortical bone) showed significant associations.

[The influence of the traction on the wrist in the course of healing of the radius distal part comminuted fractures]. / Znaczenie i wplyw sil rozciagajacych na nadgarstek w leczeniu przezstawowych i wieloodlamowych zlaman dalszej czesci kosci promieniowej dystraktorem zewnetrznym.

Traction and external fixation are the methods of choice by treating the comminuted fractures of the distal part of the radius. Bringing in two screws into the second metacarpal bone and the radius proximity from the fracture makes possible the traction and fixate the fractured bone splinters. The reposition of the comminuted fractures needs a very strong traction and provides to expand the ligaments and the wrist articular capsula. The aim of our study is to explain the mechanical influence of the external stabilization on the wrist and the wrist function after the immobilisation with the distraction. In 15 patients the examination was performed. The wrist was estimated on the base of clinical examination and rentgenography. Those examinations were performed within the moment of reduction of the dislocation, than 6 weeks and after next 6 weeks. All results are illustrated on graphics and x-ray pictures. The results of our study prove the profitable influence of the traction on the healing of the damaged articular surface in good clinical and functional position. Even a strong traction has in comparison to the control group (healing conservatively or by using various methods of the internal fixation) no influence on the wrist function.