[Polyethylene faults as causes for failure in total hip replacement]. / Wady polietylenu jako przyczyny niepowodzen w alloplastyce stawu biodrowego.

The paper deals with polyethylene faults leading to failure in total hip replacement. The material has well known advantages and is widely used but has also significant disadvantages: excessive wear of some cups, delamination and peeling of the bearing surface of the cup, fracture and fragmentation of the cup and inducing adverse biological reactions that might lead to the loosening of the implant. Final modeling of the polyethylene cup, radiation sterilization and biological factors can alter internal structure of the polyethylene and change mechanical properties of the cup with failure of the hip arthroplasty resulting.

[Acute pancreatitis as a distant complication of partial gastrectomy by the Billroth II method]. / Ostre zapalenie trzustki jako odlegle powiklanie resekcji zoladka sposobem Billroth II.

The paper presents a patient with acute pancreatitis (AP) after partial gastrectomy by means of Billroth mode. AP was caused by the occlusion of the intestinal afferent loop and the secondary pancreatic duct retention. The occlusion resulted from gastrointestinal anastomosis performed arterior to the transverse colon and adhesion.

[Diabetic foot syndrome in clinical practice. I. A model of a Diabetic Foot Consulting Unit]. / Zesp57ol stopy cukrzycowej w praktyce klinicznej. I. Model Gabinetu Stopy Cukrzycowej.

Complex pathogenesis of the foot syndrome involving a number of body system and tissues provided us with grounds for making multispecialistic assessment of its severity. Also a decision about the type and intensity of procedure should be multispecialistic. An interdisciplinary team consists of a diabetologist, diabetic educator, podiatrist, kinesitherapist, orthopedist, general and vascular surgeon and a consultant from manufacturing corrective shoes. The make-up of the team implies that the procedure includes education, metabolic normalization of diabetes mellitus, orthopedic correction, possible surgical intervention and rehabilitation. Results discussed in part II of the study indicate the effectiveness of such approach.

[Diabetic foot syndrome in clinical practice. II. Results after one year at the Diabetic Foot Consulting Unit]. / Zespól stopy cukrzycowej w praktyce klinicznej II. Wyniki rocznej dzialalnosci Gabinetu Stopy Cukrzycowej.

The study included 46 patients with the diabetic foot syndrome and ulcerations, and 40 patients with high-risk foot. Mean duration of hospitalization of the patients with ulcerations was 54 days, mean daily glycemia decreased from 162.5 mg% to 114.9 mg%. Ulcerations were completely healed in 93.5% of patients, whereas high and partial foot amputation was high and 3.2% of patients, respectively. The annual amputation rate was 2.3% in the entire group of diabetic foot patients (86). The present results indicate the necessity for adoption of a multidisciplinary approach to the problem of diabetic foot. It may be added that cooperation in glycemia normalization and patients education may decrease the number of amputations, and hence the degree of physical disability in diabetic foot patients.

The histological appearance of the periprosthetic capsule in failed total hip arthroplasty differs depending on the presence of polyethylene acetabulum destruction, iliac bone damage and presence of infection.

Aseptic loosening of the prosthesis is the most common complication of the total hip replacement. The tissues resected on revision surgery often contain polyethylene debris, originating from the worn prosthesis, as well as the fragments of acrylic cement. These foreign bodies are accompanied by various patterns of inflammatory reaction. We compared the elements of the histological picture of periprosthetic capsules from 20 patients with the clinical data, the appearance of the failed prosthesis and the state of the surrounding bone. As a result, we were able to identify characteristic morphological features linked with the aseptic implant loosening compared to the infection group. Among the aseptic implant loosening cases, those with the polyethylene acetabulum damage were associated with the more florid giant cell reaction and diffuse hyalinization of granulation tissue. The iliac bone damage was usually accompanied by more abundant cement fragments, lymphoid infiltrate and solid acellular islands of hyaline. Thus we suspect, that there are at least two mechanisms leading to aseptic failure of the total hip replacement.

Changing crystallinity of polyethylene in the acetabular cups of Weller hip prostheses.

We performed thermal analysis of polyethylene samples obtained from 73 new cups of the Weller hip prosthesis. There were marked individual differences in the degree of their crystallinity, ranging from 37.8% to 67.2% with a mean of 53%. Analysis of polyethylene from removed cups also showed differences in crystallinity in individual cups, with the mean value being higher in the removed implants than in the new ones. This difference in crystallinity between the groups was statistically significant. Marked individual differences in the degree of cup wear may result from these changes.

[Fibrous dysplasia of bone]. / Dysplazja wlóknista kosci.

The natural history, clinical and radiological manifestation and surgical treatment of fibrous dysplasia of bone have been presented.

Implantation of peripheral neural stump into muscle and its effect on the development of posttraumatic neuroma.

Dissection of the peripheral nerve is associated inherently with the development of posttraumatic neuroma on the end of the proximal stump of damaged nerve. It is unfavourable, as it causes pain on the side of dissected nerve and additionally it is an obstacle in case of secondary surgical reconstruction of the nerve. Among many methods of treating stumps of dissected nerves in order to avoid the development of neuromas, it is recommended to sew the proximal stump of dissected nerve into the venter of adjacent skeletal muscle. The present study is an evaluation of histological changes occurring at the borderline between nerve and muscle after implanting the proximal stump of dissected femoral nerve into the venter of skeletal muscle. The experiments were carried out in 30 WAG rats in which sciatic nerves were cut and the proximal end of the nerve was introduced into the venter of the adjacent muscle. The nerves with muscular fragments were obtained for histological analysis at 3, 5, 10, 20 and 40 days. In no specimen signs of developing posttraumatic neuroma were found.

Heterotopic induction of osteogenesis in the course of neural injury.

Encountered in orthopedics cases of accelerated bone union and abundant formation of the callus in patients after craniocerebral injuries as well as cases of extraskeletal ossification in neural diseases give rise to a question whether neural damage affects in any way the course of osteogenesis. The present study was carried out in an attempt to answer this question in an animal model. The study included 120 inbred WAG rats in which heterotopic induction of osteogenesis was performed by intramuscular placement of decalcified and lyophilized implants of rat cortical bones. By producing various neural damages their effect on the course of osteogenesis was evaluated. The rats were divided into four groups of 30 subjects each. In group I cerebral cortical damage was induced by intracortical injection of kainic acid solution, in group II paraplegia was produced by transverse dissection of the spinal cord on the level of Th 10-11, in group III denervation of the hind limb was performed by dissection of all supplying peripheral nerves, group IV consisted of controls. An attempt was made to evaluate changes in the course of osteogenesis while observing advancing with the passage of time changes in histological patterns of the preparations obtained from the site of bone implantation at 3, 5, 10, 20 and 40 days after the operation. While analyzing the histological pattern I paid attention to features characteristic for the process of osteogenesis such as: formation of granulation around bone grafts, penetration of mesenchymal cells into transplants, differentiation of mesenchymal cells into osteogenic cells, formation of bone tissue and development of bone marrow. The rate of development of these features in the consecutive preparations reflected the dynamics of induced osteogenesis. Analysis of the results showed that experimentally induced neural damage affects the course of osteogenesis. In case of cerebral cortical injury and peripheral neurotomy the formation of granulation around bone grafts was very abundant, whereas penetration of mesenchymal cells into the implants and differentiation of mesenchymal cells into chondroblasts occurred more rapidly than in other animal groups. In contrast, spinal cord injury resulted in a markedly decreased dynamics of osteogenesis which was manifested by weaker cell reaction around the implants and delayed differentiation of mesenchymal cells into chondroblasts. The effect was seen on the 20th day. In the final stage of the study--at 40 days--the effect of neural damage on the course of osteogenesis was reduced and the histological pattern was similar in all animal groups.(ABSTRACT TRUNCATED AT 400 WORDS)

[Fracture of the acetabular cup as an early complication of total hip replacement]. / Zlamanie panewki polietylenowej jako wczesne powiklanie calkowitej alloplastyki stawu biodrowego.

The authors have presented 12 patients with non traumatic fracture of the acetabular cup of the Weller hip prosthesis. All the fractures have occurred 10 to 40 months following hip arthroplasty 9 of the broken sockets have been removed at the time of revision arthroplasty. They showed marked destruction with multiple fragmentation of the polethylen. The area of the destruction was surrounded by active tissue reaction described as resorbtion granulation. The remowed fragments of the polethylen have been examined physicochemically and showed marked increase in the degree of crystalisation. The authors have come to the conclusion that the main reason for the failure of the presented series of the polietylene cups was defect of the material used in their production.

Associated injuries in patients with spinal injury.

The associated injuries found in 100 consecutive spinal injuries are described. Fifty-one of the patients had injuries of the cervical cord, 31 per cent complete. A total of 75 per cent of the patients had associated injuries, the commonest being a head injury. Chest injuries were the next most frequent. The management of these injuries in the presence of a severe spinal injury is described. The importance of early tracheostomy and prophylactic anticoagulant therapy is stressed in reducing the mortality to the order of 2 per cent. The value of spinal injury units is emphasized.