Optical Coherence Tomography-Angiography of Different Choroidal Neovascularization Subtypes in Wet Age-related Macular Degeneration.

Age-related macular degeneration is a leading cause of irreversible vision loss in individuals over 55 years of age worldwide. Conventionally, it is divided into two subtypes - dry (non-neovascular) and wet (neovascular) form. Neovascular age-related macular degeneration comprises only 10-15% of all patients but is responsible for more than 80% of blindness related to the disease. It requires early diagnosis and timely treatment. Fluorescein angiography is the current 'gold standard' for diagnosing neovascular forms. However, as an invasive procedure, it may be contraindicated in some circumstances and cause serious adverse effects. Optical coherence tomography-angiography is a relatively new, non-invasive and fast imaging modality gaining popularity in the diagnosis of age-related macular degeneration, especially for the neovascular form of the disease. It enables structural and functional information of blood vessels in the retina and choroid, without the need of an intravenous dye. In this study we present and discuss 3 cases of different subtypes of choroidal neovascularization secondary to neovascular age-related macular degeneration. All of them were examined by fluorescein angiography and optical coherence tomography-angiography. The results were qualitatively analyzed.

The benefits to functional ambulation and physical activity of group-based rehabilitation in frail elderly Bulgarians undergoing total knee arthroplasty. Preliminary results.

OBJECTIVES: Frailty is a geriatric syndrome associated with increased vulnerability of older adults. Knee osteoarthritis (OA) is the most prevalent joint disease and one of the leading causes of disability and poor physical activity (PA) of elderly individuals worldwide. Total knee arthroplasty TKA has been recognized as an effective surgical treatment in end-stage of knee OA. There is a lack of consensus regarding the universally accepted rehabilitation protocol for frail elderly subjects after TKA. AIM: to evaluate the potential benefits in functional ambulation (FA) and PA among frail elderly Bulgarian subjects underwent TKA, a novel group-based rehabilitation protocol was performed from the subjects. MATERIALS AND METHODS: A total of 130 frail elderly Bulgarian TKA recipients (67 women and 63 men aged 72, 69 ± 0.44,) were included. FA was assessed by the six-minute walking distance (6MWD). PA was evaluated by the PASE questionnaire. Participants were evaluated one week before TKA, as well as 3 and 6 months after the group-based rehabilitation. RESULTS: Significant increase in FA was observed at the third and sixth month after the group-based intervention (p< 0.001). PASE score, was increased at the third and sixth month after the group-based intervention (p<0.001, r2=0.74). CONCLUSIONS: Our results suggest that the applied group-based intervention led to a significant improvement in FA as well as in PA of frail elderly subjects over the first six months after the group-based intervention.

Hemivertebra of the cervical spine: an uncommon background for neck pain, cervical scoliosis, and torticollis.

A 15-year-old female patient presented with neck pain accompanied by cervical scoliosis, on the existence of torticollis. Although rare, hemivertebra of the cervical spine is a congenital deformation associated with these three clinical features.

Comparative analysis of the results obtained after unicondylar knee arthroplasty and high tibial osteotomy in isolated gonarthrosis.

UNLABELLED: The AIM of this study was to analyse the results of the surgery and compare the outcomes of unicondylar knee arthroplasty and high tibial osteotomy performed in isolated gonarthrosis. PATIENTS AND METHODS: Between 2007 and 2011, 65 patients were implanted a partial knee endo-prosthesis in the Clinic of Orthopedics and Traumatology. Men were 23 (35.4%) and women were 42 (64.6%). High tibial osteotomy was performed to manage the unicompartmental gonarthrosis in 92 patients (47 men and 45 women) for 13 years between 1975 and 1987. These two modalities were used only in cases in which one of the knee joint compartments was affected. Clinical, para-clinical, functional tests and radiographic examination were conducted of the affected knee joint. RESULTS: The results of the study were assessed by the rating system proposed by the Knee Society and modified by John Insall. At four-year follow-up study the outcomes of the partial prosthesis were assessed as excellent in 85.13%, good--in 13.11% and satisfactory in 1.77% of patients. After high tibial osteotomy the results were considered very good in 54.18% of patients, good--in 32.29%, satisfactory--in 6.25%, and poor--in 7.8%. CONCLUSIONS: Partial knee arthroplasty is a resurfacing procedure, while high tibial osteotomy is used only to slow the overall degenerative process with gradual progressive exacerbation of osteoarthritis with age. The results after prosthetic treatment had a better dynamics than that in high tibial osteotomy.

A case of pelvic bone hydatidosis--diagnosis and treatment.

INTRODUCTION: Echinococcosis is a frequent helminthiasis in Bulgaria. Hydatid cysts commonly affect the liver and the lung. Echinococcosis rarely involves bones (0.5 to 2.5%) and vertebral column is affected in 50% of the cases. PATIENTS AND METHODS: We report a case of a 67-year-old female with echinococcosis of the pelvic bone clinically manifested by pain and swelling of the right iliac region and complicated by abscess of the surrounding soft tissue. The patient underwent surgery at the Department of Orthopedics and Traumatology, University hospital "St. George", Medical University, Plovdiv. Diagnosis was based on imaging findings, serologic and histological methods. Biopsy material was investigated by standard histological methods hematoxilin-eosin (H-E),PAS and hydrargyrum impregnation after Gommori, which presented both chitin and germinative membranes of the hydatid cyst. RESULTS: The patient underwent complete resection of the bone lesion along with the surrounding soft tissue. Purulent collection of 1200 ml was evacuated. A six months follow-up of the patient revealed no pathology of the cyst and other organs. She walked unaided. No echinococcosis recurrence was observed on control examinations. CONCLUSIONS: Hydatid bone disease is usually difficult to diagnose. Its treatment includes excision of bone lesion, curettage and oral therapy. It is not always possible to fully remove all the affected bone fragments especially when cysts are located in the femoral and pelvic bones. In the reported case the hydatid cyst was fully removed by resection of the right iliac ala and the patient's mobility was preserved.

Complications in total hip replacement.

AIM: THE PURPOSE of the present study was to present the most common treatment failures and complications associated with total hip replacement. MATERIAL AND METHODS: Between 1986 and 2002, 486 total hip replacements (THR) in 403 patients were performed at the Clinics of Orthopedic and Trauma Surgery (St. George University Hospital, Plovdiv). 315 (61.8%) of the patients underwent THR for coxarthrosis, 171 (35.1%)--for traumatic or pathologic subcapital femoral neck fractures. 312 (64.2%) of the patients were women and 174 (35.8%) were men. Right and left arthroplasties were carried out. Patients' age was in the range of 28 to 53 years (median age 59.6). Complications were diagnosed in 97 (19.9%). Late postoperative complications (53.6%) as aseptic loosening of the prosthetic components, superficial and deep hematogenous infections, prosthetic dislocations and heterotopic ossifications were predominant. RESULTS: Complications were categorized as intraoperative, postoperative and late--a finding, consistent with the data in the literature. Among the intraoperative complications most common were malposition of the capsule (7 patients) and of the stem (4 patients) and longer stem (in 1 patient), but they caused no complaints. The postoperative complications consisted of hematomas and seromas wich were treated with early revision surgery. The main causes for late complications were postoperative ossification in 28 patients. Aseptic loosening of the prosthesis was seen in 11 patients. 8 of them complained of acetabular and 3 of thigh pain. Capsule dislocation was registered in 3 patients. CONCLUSIONS: Complications in THR are not infrequent. Their avoidance is largely dependent on the skill and qualification of the team and the quality of hospital care. Adequate risk assessment and prophylaxis are essential in disease outcome.

The holistic approach to rehabilitation of patients after total hip joint replacement.

AIM: The objective of the present study was to present the principles of a program used jointly by the Clinic of Orthopaedics and Traumatology and the Clinic of Physical Medicine and Early Rehabilitation at St. George University Hospital, Plovdiv for rehabilitation of patients with total hip replacement surgery. MATERIALS AND METHODS: We reviewed 486 cases of endoprostheses implanted by two surgical teams in the Clinic of Orthopaedics and Traumatology over a period of 6 years. We lay the stress on the fact that early mobilization of patients (3 to 5 days after operation) results in better functional results. We particularly emphasize the necessity of using a comprehensive approach that can have an effect on the psychoemotional status and the motivation of patients. RESULTS: The treatment results we evaluated by taking into account not only all functional parameters of restoring the range of hip joint motion but also the psychoemotional aspects of the recovery of patients after surgery. We took into consideration the range of motion of both the operated and the unoperated hip joints, the muscle strength, the walking distance, the type of gait, and the subjective evaluation of the patients (satisfied, not very satisfied, unsatisfied of operation). Particular attention was paid to the psychoemotional status of patients stimulating the positive feedback and their willingness to put in serious efforts toward improvement of their quality of life. CONCLUSION: The new approach to rehabilitation of patients with total hip replacement focuses not only on the collaboration between orthopedists, traumatologists and physical therapeutists, but also on the integral effect both on the physical state of patients and on their psychoemotional status with the aim of improving their quality of life.