Effectiveness of reverse total shoulder arthroplasty for primary and secondary fracture care: mid-term outcomes in a single-centre experience.

BACKGROUND: The introduction of reverse total shoulder arthroplasty (RSA) as a treatment option in complex proximal humeral fractures, has significantly extended the surgical armamentarium. The aim of this study was to investigate the mid-term outcome following fracture RSA in acute or sequelae, as well as salvage procedures. It was hypothesized that revision RSA (SRSA) leads to similar mid-term results as primary fracture treatment by RSA (PRSA). METHODS: This retrospective study describes the radiological and clinical mid-term outcomes in a standardized single-centre and Inlay design. Patients who underwent RSA in fracture care between 2008 and 2017 were included (minimum follow-up: 2 years, minimum age: 60 years). The assessment tools used for functional findings were range of motion (ROM), Visual Analogue Scale, absolute (CS) plus normative Constant Score, QuickDASH, and Subjective Shoulder Value. All adverse events as well as the radiological results and their clinical correlations were statistically analysed (using p < .05and 95% confidence intervals). RESULTS: Following fracture RSA, 68 patients were included (mean age: 72.5 years, mean follow-up: 46 months). Forty-two underwent primary RSA (PRSA), and 26 underwent revision RSA (SRSA). Adverse advents were observed in 13% (n = 9/68). No statistically significant results were found for the scores of the PRSA and SRSA groups, while the failed osteosynthesis SRSA subgroup obtained statistically significantly negative values for ROM subzones (flexion: p = .020, abduction: p = .020). Decreased instances of tubercle healing were observed for the in PRSA group relative to the SRSA group (p = .006). The absence of bony healing of the tubercles was related to significant negative clinical and subjective outcomes (all scores: p < .05, external rotation: p= .019). Significant postoperative improvements were evaluated in the SRSA group (CS: 23 to 56 at mean, p = .001), the time from index surgery to operative revision revealed no associations in functional findings. CONCLUSIONS: RSA is an effective option in severe shoulder fracture management with predictable results for salvage as well as first-line treatment. Promising mid-term functional results, reasonable implant survival rates, and high patient satisfaction can be achieved. LEVEL OF EVIDENCE: Level III.

Feasibility of arthroscopic 3-dimensional, purely autologous chondrocyte transplantation for chondral defects of the hip: a case series.

INTRODUCTION: The purpose of this retrospective study was to describe technical aspects of arthroscopic, purely autologous chondrocyte transplantation of the hip and to report short-term data of the postoperative outcome in a consecutive series of patients. MATERIALS AND METHODS: We retrospectively analyzed six patients with a full-thickness chondral defect of the hip joint. The defect was treated with an arthroscopically applicable 3-dimensional purely autologous chondrocyte transplant product (chondrosphere(®); co.don(®) AG, Berlin, Germany) in a two-step surgical procedure. Patient-administered scores were assessed at baseline (day before transplantation) and at 6 weeks, 3, 6 and 12 months. RESULTS: Six out of six initially included patients (five males, one female) with a median age of 32.5 years and an average defect size of 3.5 cm(2) were available for follow-up after a mean of 11.2 months. Five acetabular and one femoral defect were treated. An overall statistically significant improvement was observed for all assessment scores (NHS, mHHS and SF 36). CONCLUSION: In this study, we displayed the feasibility and technical aspects of arthroscopic matrix-associated, purely autologous chondrocyte transplantation as a treatment option for full-thickness cartilage defects of the hip. The patient-administered assessment scores demonstrated an increase in activity level and quality of life after a 1-year follow-up. LEVEL OF EVIDENCE: Level IV, retrospective study.

Assessment of the diagnostic value of dual-energy CT and MRI in the detection of iatrogenically induced injuries of anterior cruciate ligament in a porcine model.

INTRODUCTION: Magnetic resonance imaging (MRI) is the standard of reference for the non-invasive evaluation of ligament injuries of the knee. The development of dual-energy CT (DE-CT) made it possible to differentiate between tissues of different density by two simultaneous CT measurements with different tube voltages. This approach enables DE-CT to discriminate ligament structures without intra-articular contrast media injection. The aims of this study were on the one hand to determine the delineation of the anterior cruciate ligament (ACL) and on the other hand to assess the diagnostic value of DE-CT and MRI in the detection of iatrogenically induced injury of the ACL in a porcine knee joint model. MATERIALS AND METHODS: Twenty porcine hind legs, which were placed in a preformed cast in order to achieve a standardized position, were scanned using DE-CT. Thereafter, a 1.5-T MRI using a standard protocol was performed. The imaging procedures were repeated with the same parameters after inducing defined lesions (total or partial incision) on the ACL arthroscopically. After post-processing, two radiologists and two orthopedic surgeons first analyzed the delineation of the ACL and then, using a consensus approach, the iatrogenically induced lesions. The result of the arthrotomy was defined as the standard of reference. RESULTS: The ACL could be visualized both on DE-CT and MRI in 100% of the cases. As for the MRI, the sensitivity and specificity of detecting the cruciate ligament lesion respectively compared with the defined arthrotomy was 66.7% and 78.6% for intact cruciate ligaments, 100% and 75% in the case of a complete lesion, 33.3% and 78.6% for lesions of the anteromedial bundle, and 0% and 100% for lesions of the posterolateral bundle. In comparison, DE-CT demonstrated a sensitivity and specificity of 66.7% and 71.4% in the case of intact cruciate ligaments, 75% and 68.8% in the case of completely discontinued ACLs, 0% and 92.9% in the case of lesions of the anteromedial bundle, and 25% and 87.5% in the case of lesions of the posterolateral bundle. CONCLUSIONS: The present ex vivo experiment shows that both study modalities (DE-CT and MRI) are equal with regard to the delineation of the ACL, while MRI achieved higher sensitivity and specificity regarding iatrogenically induced complete ACL lesions. DE-CT could be a possible alternative to MRI for certain indications in the diagnosis of a knee ligament injury.

Complications of video-mediastinoscopy--successful management in four cases.

The authors describe complications of video-mediastinoscopy in a number of clinical cases and present case reports of four patients, where this complication occurred. The following types of complications were recorded: one case of esophageal perforation, one case of tracheal lesion and two cases of massive bleeding from central greater vessel. Possibilities of treatment methods of these complications, possible ways how to manage and decrease the incidence of life-threatening complication are being discussed in this paper. (Fig. 5, Ref. 9.).

[NK cell activity and association with the HLA class I antigen complex]. / NK-aktivita a asociácia s antigénmi triedy I HLA-komplexu.

To contribute to the genetic regulation of NK cell cytotoxic activity an association between HLA antigens and a level of cytolysis of target cells (K-562) have been followed. By investigating of NK cell cytotoxic activity in 183 HLA-typed healthy persons it was found that high levels of cytolytic function of NK cells were associated with the antigens of HLA-B8, HLA-B27, HLA-B40, and HLA-B44 as well as the HLA-A2,-B12 phenotypes (in male only). It was also found that low NK cell cytotoxic activity was significantly correlated with homozygosity at HLA loci. These results suggest that HLA genes or genes linked with them may control NK cell cytotoxic functions in man. The authors have also suggested that above mentioned HLA-B antigens might belong to the activating receptor family of NK cells. (Tab. 7, Ref. 48.)

Genetic polymorphism of factor B (Bf) and C3 component of complement in type 1 (insulin-dependent) diabetes mellitus: BFQO allele observed in a diabetic child.

C3 and Bf polymorphisms were studied in 215 and 192 children with type 1 diabetes mellitus (IDDM), respectively. No significant differences in C3 phenotypes and allele frequencies were found between IDDM patients and a healthy population. The rare allele BfF1 was found in 9.37% of diabetic patients but in only 0.35% of the general Slovak population (0.0468 vs. 0.0017). An increased frequency rate of BfSO.7 was also observed in 8.85% of IDDM patients compared with 3.57% of healthy controls (0.0442 vs. 0.0178). The relative risk was 28.83 for BfF1 and 2.55 for BfSO.7. One diabetic child was found to be heterozygous for a silent allele BfQO. This rare Bf allele was transmitted to the boy from his healthy mother.

[Possibilities of finding identical HLA donor-recipient pairs for bone marrow transplantation]. / Moznosti výberu HLA-identickej dvojice darca--príjemca na transplantácie kostnej drene.

With the aim to detect genotypically identical donors for patients suffering from some type of leukemia or aplastic anemia, HLA antigens and MLC reactivity were determined in 72 families, having together 209 children. HLA identical, MLC negative sibling donors were found for 31 patients, i.e. 43%. Compared to the healthy population, no significant differences were found in the frequency of HLA antigens and haplotypes in 58 leukemic patients. Two recombinations were recorded, one between the loci HLA-A and HLA-B, and the other one between HLA-B and HLA-D/DR. Only 9 persons (2.5%) homozygous for HLA-D antigens were found in the whole series of 353 subjects investigated.

Quantification of proliferative and suppressive responses of human T lymphocytes following ConA stimulation.

The mitogenic response of human T lymphocytes to graded doses of concanavalin A (ConA) has been measured by means of an MTT tetrazolium dye metabolic assay. Three groups of healthy subjects, representing children, younger adults and elderly persons, were investigated. It was shown that a typical bell-shaped course of the ConA dose-response curve is the result of a proliferative response to suboptimal concentrations of ConA and a toxic action of ConA at supraoptimal concentrations. The ascending part of the response curve reflects in its shape the regulatory interaction of responding cells. A decrease in suppressive functions is accompanied by a shift of this part of the curve to lower concentrations of ConA. By means of a mathematical model derived from enzyme kinetics, an attempt was made to quantify the suppressive functions from the course of the individual dose-response curve. It was found that after suitable data processing, suppression-related shape changes can be assigned to a single parameter. The value of this parameter as a diagnostic tool was tested in a study of the age dependence of human T lymphocyte responses to ConA. While the proliferative response decreased with age, the suppressive functions exhibited their maximum effect in the group of adults. Thus it could be demonstrated that ConA induced proliferative and suppressive responses are due to two different pathways which can be independently extracted from the dose-response curve.

Genetic polymorphism of factor B of the complement system (Bf) in the Slovak population.

The distribution of factor B (Bf) phenotypes and gene frequencies were investigated in 280 genetically unrelated persons of the Slovak population. Thin-layer agarose gel high-voltage electrophoresis and subsequent immunofixation were used. A low frequency of the "rare" allele BfFl was observed (BfFl = 0.0017). The frequencies of common Bf alleles BfS and BfF (BfS = 0.816, BfF = 0.1625) and a "rare" allele BfSO.7 (BfSO.7 = 0.0178) were inside the corresponding ranges of BfS, BfF and BfSO.7 found in European Caucasoids. No other variants were observed.

Occurrence rate of the HLA-identical pair donor-recipient for bone marrow transplantation.

HLA antigens and MLC reactivity were ascertained in 69 families, having altogether 198 children, with the aim to find genotypically identical donors for patients suffering from some type of leukemia or aplastic anemia. HLA identical, MLC negative sibling donors were found for 29 patients, i.e. 42.03%. In 55 leukemic patients the frequency of HLA antigens and haplotypes was calculated. No significant differences were found as compared to the healthy population. One recombination between HLA-A and HLA-B and one between HLA-B and HLA-D/DR loci were observed.

Genetic determination of phagocytic activity of polymorphonuclear leucocytes.

Sixty-three persons with the known HLA-A, -B, -C, -DR and -Dw antigens were investigated for phagocytic ability, candidacidal activity, respiratory burst values, and the levels of circulating immune complexes, C2, C4, IgG, IgM, and IgA. The investigated persons were divided into the HLA-DR2/Dw2, the HLA-DR3/Dw3 and a control group, members of which possessed neither antigen in question. The phagocytic activity of polymorphonuclear leucocytes ingesting dead cells of C. albicans and the candidacidal activity were found to be significantly lower (P less than 0.02) in the HLA-DR3/Dw3 compared to the control group. The respiratory burst values did not considerably differ in all three groups under study. The levels of circulating immune complexes were higher in both the HLA-DR2/Dw2 and HLA-DR3/Dw3 in comparison with the control group.

Deficiency of C2, the second complement component, in the family of a patient with SLE-like syndrome: the first case of hereditary C2 deficiency in Czechoslovakia.

A family with hereditary C2 deficiency was discovered in Czechoslovakia. The proband is a 47-year-old female with a SLE-like syndrome and zero activity of the classical complement pathway. Functional CH50, C1, C2, and C4 estimations for all family members revealed a homozygous C2 deficiency in both the proband and her elder sister, and several heterozygotic C2-deficient individuals. The defect segregates with haplo-type HLA A25, B18, DR2.

A standard microcytotoxicity technique for quantitative analysis of lymphocyte subsets. A comparison with indirect immunofluorescence, evaluated by microscopy or flow cytometry.

A standard complement-dependent microcytotoxicity (CDC) technique was used for quantitative analysis of T-lymphocyte subsets in human peripheral blood and the results compared to those obtained by indirect immunofluorescence microscopy and flow cytometry. The monoclonal antibodies OKT3, OKT4 and OKT8 were used in the CDC method for detection of total-T cells, T-helper and T-suppressor cells respectively. The CDC technique provided reproducible results (CV, 3-7%) correlating well with both immunofluorescence techniques. This observation was valid both for healthy persons (n = 21) and for patients (n = 10) with immunological disorders. The correct antibody dilution, correction for background and the use of eosin staining are considered critical for the usefulness of this technique. The method has several advantages: it is widely used for histocompatibility testing, only simple equipment is necessary, and the amount of monoclonal antibody required per test is small.