Polymorphisms of biotransforming enzymes (GSTs) and their association with colorectal cancer in the Slovak population.

The aim of present study was to summarize the results of a case-control study focused on genetic polymorphisms of selected Phase II metabolizing enzymes (GSTM1, T1, P1) and to investigate the association of these polymorphisms with the colorectal cancer risk among the Slovak population. A case-control study with 183 colorectal cancer cases and 422 controls was conducted. DNA was extracted from peripheral blood leukocytes, and the polymorphisms of GSTM1, GSTT1 and GSTP1 enzymes were determined by PCR-based methods. Association between specific genotypes and the development of colorectal cancer were examined using logistic regression analysis to calculate odds ratios (OR) and 95% confidence intervals (CI). The GSTP1 val/val genotype (OR=2.1, 95%CI: 1.1 - 4.0, chi2 = 0.28 and P = 0.0025) was associated with an elevated risk. The statistically significant correlation was found also for the combined genotypes of GSTM1 null and GSTP1 valine homozygosity (OR = 2.7, 95% CI: 1.1-6.1, chi2 = 4.5 and P = 0.03). The genotype of certain metabolising enzymes affects the risk for colorectal cancer. This effect is also important when certain allelic combinations are studied. In the near future, individual risk assessment may be reached by further increasing the number of studies of polymorphisms, combining them with the traditional epidemiological risk factor.

[Vascular and neurological complications of supracondylar humeral fractures in children]. / Cievne a neurologické komplikácie suprakondylických zlomenín humeru u detí

The author reports two cases of pediatric patients with supracondylar humeral fractures complicated by concomitant vascular injury. One of the patients also presented with neurological symptoms from compression of the ulnar and median nerves. In the case of vascular injury only, it was necessary to resect a 1-cm segment of the brachial artery which was thrombosed due to intimal disruption. In the other case, surgery was not indicated immediately; however, liberation of the nervus ulnaris and nervus medianus was later required because of nerve compression by the scar and bone. The author considers the exact diagnosis, precise reduction and stable fixation of a fracture to be most important for a good outcome of treatment. Any associated vascular injury is indicated for surgery only after a thorough diagnostic consideration, and may not be needed in every case. The most decisive factor is the clinical presentation. Injury to the nerve system is indicated for surgical treatment at a later period, at 3 months post-injury at the earliest.

[Ten-year experience with the Aldinger custom-made total hip arthroplasty: evaluation of the results]. / 10-rocné skúsenosti s individuálnou TEP podla Aldingera - zhodnotenie výsledkov.

PURPOSE OF THE STUDY: The author presents the results of treatment with total hip arthroplasty (THA), in the Aldinger modification, in 91 patients receiving a total of 98 custom-made total hip implants in the period from 1993 to 2002. Eighty-eight patients (96.9 %) with 95 THAs were available for evaluation at the last follow-up. MATERIAL: The group comprised 26 men (27 total hip implants), at an average age of 33.8 years (range, 25-57), and 65 women (71 implants) at an average age of 38.5 years (23-57) at the time of surgery. The right hip was operated on in 43 patients (18 men and 25 women) and the left one in 55 patients (9 men and 46 women). One man and six women underwent bilateral THA. The average time between the operation and the last follow-up was 8.6 years (range, 3 years and 11 months to 13 years and 3 months). METHODS: The author describes the complete procedure from indications, planning and manufacture of an custom made implant to its implantation in combination with different types of acetabulum. The evaluation based on the Merle d'Aubigné score system, as modified by Griss, was carried out for an average follow-up of 8.6 years. RESULTS The outcomes were excellent, good and satisfactory in 69 (72.7 %), 16 (16.8 %) and 8 (8.4 %) patients, respectively. Two patients with septic complications (2.1 %) reported poor results. The overall complications involved aseptic loosening of the acetabulum in five, septic loosening of the acetabulum with severe lesions due to polyethylene wear in three, and infection in four patients. Eight cases were associated with periarticular ossifications and three patients developed deep venous thrombosis in the post-operative period. DISCUSSION: The prerequisite for good outcomes in total hip arthroplasty using cementless implants is, in the author's opinion, the attainment of high primary stability. One of the options to achieve this is a thorough analysis of proximal femoral morphology on CT scans, which permits the construction of an custom made implant to each individual femur on the form-fit principle. Other advantages include a possibility to adjust the torsion angle of the femoral neck, to plan correction of limb length and to restore femoral offset, which provides conditions for optimal geometry of the hip joint. The excellent and good outcomes recorded in nearly 90 % of our patients at an average of 8.6 years of follow up are in agreement with the literature results. The fact that most of our complications were due to aseptic loosening of the acetabulum suggests that the use of a custom-made hip implant does not resolve the problems associated with acetabular dysplasia. A true loosening of the custom made stem occurred in only two cases with septic complications, in which any other type of stem would have behaved in a similar way. The same findings are also reported by other authors. CONCLUSIONS: The results of this study show that the idea of exact adjusting of an implant to the bone (not vice versa) could meet the requirement for the implant's long life span and could allow for better physical therapy in the post-operative period, particularly in young patients with secondary post-traumatic or post-dislocation arthritis of the hip. Cemented hip implants, however, remain the gold standard for patients over 70 years. In younger patients it is necessary to put more emphasis on stable primary fixation, which can be achieved by 3D reconstruction of the joint to be replaced, by imaging methods and a subsequent computer processing of the procedures for designing, manufacturing and inserting the hip prosthesis. Key words: custom-made prosthesis, Aldinger modification, hip arthritis, functional results.

Oral N-acetylcysteine reverses hyperoxia-related cough suppression in guinea pigs.

Hyperoxia-induced lung injury is well known in animal and human studies. We have previously shown that hyperoxic exposure of guinea pigs is associated with suppression of cough reflex. The goal of this study was to determine the effects of oral N-acetylcysteine (NAC) on hyperoxia-induced oxidative stress in lung tissue directed on cough reflex. The experimental group was pretreated with NAC daily for 7 days and subsequently exposed to 100% O2 for 60 h. Hyperoxic group inhaled 100% O2 only. The control group was exposed to normoxia. Cough was induced by inhalation of citric acid aerosol before and after exposure to oxygen. Cough was also induced by mechanical stimulation of airways in anesthetized animals just after the end of oxygen exposure. Our results showed a significant decrease (P=0.002) in citric acid-induced cough in hyperoxic animals and reversal of that effect in animals pretreated with NAC. In addition, there was a significant interaction between antioxidant therapy and hyperoxia (P=0.005). NAC also reversed the hyperoxia-induced inhibition of mechanically-induced cough. In conclusion, our results indicate that NAC attenuated hyperoxia-induced down-regulation of chemically and mechanically-induced cough.

[Treatment of acromioclavicular dislocation after bosworth.]. / Liecba akromioklavikulárnej luxácie operáciou podla Boswortha.

The authors present a group of 60 acromioclavicular dislocations of Tossy III type in 59 patients whom they operated on in the period of 1992-1996. Within the use of a variety of methods of the surgery of acromioclavicular dislocation they achieved the best results by a timely suture of the coracoclavicular ligament and stabilization of the clavicula by a Bosworth screw. They have been using this method most frequently since 1990 as when performed in time and technically correctly it is very efficient despite its certain drawbacks. The authors emphasize mainly technical aspects of a timely acromioclavicular stabilization by a cancellous screw. In the conclusion they formulate principles of the use of the method of stabilization by a screw after Bosworth for the achievement of a good functional result. Key words: acromioclavicular dislocation, acromioclavicular stabilization by a screw after Bosworth.

[A Rare Fracture-dislocation of Talus.]. / Raritná luxacná zlomenina talu.

In the introduction the authors analyze the issues of the fractures of talus which is a key connection between the foot and the lower limb. For the prognosis of the healing of fractures of the talus they consider the most important its retrograde vascularization. Further they decribe types of fractures of the talus according to Hawkins. In their view a certain role is played also by the mechanism of the injury. The core of the work is a case report of a 34-year old mountaineer who sustained a very rare fracturedislocation of the talus which was treated by open reduction and fixation by means of K-wires. During the 18-month follow-up they recorded a full bone consolidation of the fracture without any symptoms of the feared avascular necrosis. In the conclusion they compare the data in literature with their own results. Key words: fractures of talus, typology of fractures after Hawkins, surgical treatment.

[Classification of anterior instability of the shoulder by arthroscopy - the authors clinical material.]. / Klasifikácia prednej instability ramena v artroskopickom obraze v nasom klinickom materiáli.

The authors review briefly the evaluation of anterior instability of the shoulder joint from different aspects. The objective of their work was to present different types of morphological changes, as suggested by Resch (6). During the two-year period since June 1995 so far a total of 96 patients with the clinical picture of anterior instability of the humeroscapular joint were examined arthroscopically. The group comprised 69 men and 27 women, all in productive age. Type 1 lesions according to Resch were found in 52 %, type 2 in 21 %, type 3 in 6 %, type 4 in 13 %, type 5 in 1 % and type 6 in 7 % of the patients, which is consistent with data reported in the literature. In their opinion type 5 lesions are most difficult to diagnose. A certain amount of routine is needed also to differentiate type 1 and 4 and type 2 and 6 according to Resch's classification. Conversely, they consider type 3 findings standard and unequivocal. Key words: humeroscapular joint, anterior instability, arthroscopic diagnosis, type of lesions.

[Gastrointestinal Tonometry in Orthopaedics (Results of a Prospective Randomized Pilot Study GATOAN-1 in Patients with General and Regional Anaesthesia During Replacement of the Hip Joint).]. / Gastrointestinálna tonometria v ortopédii (Výsledky prospektívnej randomizovanej pilotnej stúdie GATOAN-1 u pacientov s celkovou a regionálnou anestéziou v priebehu náhrady bedrového klbu).

In the submited pilot study the authors present a recently introduced method of monitoring of the regional perfusion by gastric tonometry during implantation of an endoprosthesis of the hip joint. The objective of the investigation was in addition to introduction of a new method to assess the influence of the type of anaesthesia on markers of the gastrointestinal tract perfusion. The method was used in 10 patients aged 27 - 75 years where in four instances a cemented endoprosthesis was implanted and an uncemented one in six cases. Five times general anaesthesia was used, 5 times regional anaesthesia. During monitoring the authors assessed PrCO2, pHi, CO2 gap, pH gap, EtCO2, arterial pressure, heart rate and SaO2. The patients operated under general anaesthesia had all pathological values of pHi, two had pathological values of pH gap and one of CO2 gap. In the group with regional anaesthesia three patients had pathological pHi values, two had pathological pH gap values and one a pathological CO2 gap value. Statistical evaluation revealed a significant difference in pH gap and CO2 gap values in favour of regional anaesthesia (p = 0,03). The results of the trial indicate a better gastrointestinal perfusion in patients under regional anaesthesia and a pathological state of organ perfusion while the values of standard systemic values are unaltered. Key words: gastrointestinal tonometry, general anaesthesia, regional anaesthesia, total replacement of the hip joint.

[Incidence of congenital orthopaedic defect in the martin district (longitudinal survey).]. / Výskyt vrodených ortopedických chýb v okrese Martin (longitudinálne sledovanie).

The authors submit a model of the detection rate, monitoring and treatment of inborn defects of the locomotor system used in the Martin district. During the investigation period from 1972 - 1994 they examined and processed data from 41 281 neonates, i. e. 99,2 % of the total number of liveborn infants in the Martin district, focused specially on the hip joint and inborn defects of the foot. As to clinical symptoms of dysplasia coxae congenita they ascribe the greatest diagnostic value to Ortolani's phenomenon and abduction restricted to less than 60 degrees, which was recorded in 82 % and 52 % of the examined infants resp. As revealed by the incidence of dysplasia and dislocation in different periods, the introduction of preventive and therapeutic measures in the early neonatal stage had an unequivocal positive effect on the incidence of dysplasia and dislocation. The incidence of inborn defects of the foot was on a constant level during the investigation period. The authors did not record a significant coincidence of inborn defects of the foot and dysplasia of the hip joint in the investigated group, which is consistent with data in the literature. In the conclusion the authors emphasize the importance of prevention in the early neonatal age which leads to a reduction of the number of severe secondary coxarthroses. Key words: dysplasia coxae congenita, luxatio coxae congenita, inborn defects of the foot, prevention.

[Arthropathy of the wrist - extrapulmonary sarcoidosis.]. / Artropatia karpu v obraze mimoplúcnej sarkoidózy.

In the submitted paper the authors present a brief theoretical account and characteristics of sarcoidosis focused on its manifestations in the locomotor apparatus, found in 10 - 14 % of the patients. The course of this very rare form of sarcoidosis of the locomotor apparatus is demonstrated on a 50-year-old female patient with severe sarcoid arthropathy of the wrist. They draw special attention to diagnostic problems in extrapulmonary forms of sarcoidosis. Key words: sarcoidosis, arthropathy of the wrist, extrapulmonary sarcoidosis.

[Contribution of Three-phase Scintigraphy to Indication of Revision Arthroplasty of the Hip Joint.]. / Prínos trojfázovej scintigrafie pre indikáciu k revíznej artroplastike bedrového klbu.

In the introduction of the paper the authors abalyze the problem of stable and long-term fixation of endoprostheses of the hip joint. They present statistics on the ratio of surgical revisions of endoprostheses of the hip joint in 1993-1996 which has a rising trend. In the subsequent part of the paper they deal with the problem of early diagnosis of loosening in the stage when only subjective data reported by the patient are available and the X-ray finding does not yet show signs of osteolysis and loosening of the TEP. Therefore they started to use in 1993 as a diagnostic aid three-phase all-skeletal scintigraphy. So far they used it in 18 patients with 100% reliability, as confirmed on operation. The authors describe in detail the method of three-phase scintigraphy with special emphasis on phase III. The results of scintigraphy are demonstrated on two patients. Key words: revision of endoprosthesis of the hip joint, radiopharmaceutical preparations, 99mTc-MDP, all-skeletal three-phase scintigraphy.

[Impingement syndrome - diagnosis and treatment.]. / Impingement syndróm - diagnostika a liecba.

In the introduction the authors describe the anatomical features of the subacromial space from which the concept of impingement syndrome is derived. In a review of the literature they describe the development of views on the pathology of the subacromial space. According to Neer (11) impingement syndrome develops i three stages. In the subsequent part of the paper the authors describe structural and functional changes which have an impact on the course of the impingement syndrome. They emphasize detailed assessment of the patient's subjective complaints and describe the comprehensive clinical examination as well as X-ray imaging methods. The subsequent part is devoted to conservative and surgical treatment with special attention to arthroscopic and open subacromial decompression. The final part of the paper deals with the problem of after-treatment. Key words: impingement syndrome, anatomical definition, diagnosis and treatment of subacromial decompression after-treatment.

[Use of radiocolloids in orthopaedic practice.]. / Moznosti pouzitia rádiokoloidov v ortopedickej praxi.

The authors submit in their paper the results of treatment with radiocolloids 198Au and Y90 in patients with chronic synovialitis associated with rheumatoid arthritis, degenerative diseases, haemophilia, posttraumatic conditions, arthropathy and gout. During the period between 1970 and 1995 they administered radiocolloid 1259 times to 865 patients. Up to 1986 they administered radiocolloid of gold 198, since 1986 to the present time only radiocolloid of yttrium 90. The authors compare the results obtained with the two preparations, the results being greatly in favour for yttrium. The evaluation was made 6 months before administration and 6 months following administration of radiocolloid. Following administration of gold 198 they recorded substantial improvement in one third of the patients and improvement in half the patients. After administration of yttrium 90 44% patients improved substantially and 49% of the patients improved. A long-term effect of treatment with radiocolloids after more than six months of treatment was found after gold 198 administration in 27% patients and after yttrium 90 in 78% patients. No therapeutic response was recorded after administration of gold 198 in 29% and after administration of yttrium 90 in 22% patients. Key words: chronic synovialitis, radiosynoviorthesis, radiocolloid 198Au and 90Y.