Bilateral double-layered patella in a patient with advanced knee osteoarthritis.

Double layered patella (DLP) is a rare anomaly of the patella that may go undiagnosed, especially in patients with progressive knee dysfunction and early degenerative changes. Clinical symptoms such as motion-dependent pain and anterior knee pain most typically occur in adolescents or young adults; however, gradually increasing pain and early generalised degenerative changes have also been seen in patients over 40 years old. Diagnosis of DLP could be difficult, especially in cases with coexisting arthrosis. DLP is considered to be pathognomonic for the diagnosis of multiple epiphyseal dysplasia and usually coexists with other anomalies seen in this syndrome, such as hip dysplasia. In extremely rare cases, DLP can occur as a solitary disorder. The prevalence of such cases, however, is unknown, and they could be easily misdiagnosed. Computed tomography and magnetic resonance imaging are the most sensitive radiological methods used in DLP diagnosis. This case report presents a case of a bilateral DLP incidentally found in a 47-year-old patient with advanced arthritis referred for arthroplasty because of increasing symptoms of knee joint failure with no other abnormalities recorded. An important goal of our case study is to raise the awareness of this abnormality with radiologists and orthopaedic surgeons.

The Role of Antimicrobial Neutrophil Extract in Modification of the Inflammatory Response During Osteochondral Autograft and Allograft Transplantation in Rabbits.

Osteochondral autograft or allograft transplantation is one of the surgical options for the management of large cartilage defects; however, the mechanisms of cartilage healing after this procedure, especially the immunological mechanisms, are not fully understood. The present study examined whether a grafting procedure changed the in-vitro responses of neutrophils and monocyte-derived macrophages (MDMs). Additionally, antimicrobial neutrophil extract (ANE) was assessed for its ability to modulate excessive cellular responses during and after implantation. The neutrophil secretory response was tested by measuring enzyme release and free radical generation, while the MDM response was evaluated by assessing morphological and functional changes of the cells after polarization. Osteochondral implantation evoked a transient secretory response by circulating neutrophils, but MDMs were not activated postoperatively. ANE from rabbit blood may be considered as a modulator of the inflammatory response because of its influence on neutrophils and MDMs. Inhibition of the neutrophil secretory response prevents complications that may arise following excessive activity of these cells. Stimulation of MDMs with ANE induces formation of a partial anti-inflammatory phenotype with enhanced regenerative properties.

The effect of activated platelet-rich plasma (PRP) on tricalcium hydroxyapatite phosphate healing in experimental, partial defects of long bone shafts in animal models.

The purpose of the study was to assess the effect of autologous activated platelet-rich plasma on healing of a bone substitute - tricalcium phosphate hydroxyapatite in experimental long bone defects using an animal model. The experiment involved an animal model of femoral defect. 24 Termond white rabbits were used in the study. We evaluated the effect of autologous platelet-rich plasma on tricalcium phosphate using classical radiology, micro-CT studies, strength tests and histological evaluation. Radiological and histological assessment did not show a beneficial effect of PRP together with a bone substitute in comparison to filling the defects only with bone replacement material. The only benefit of adding platelet-rich plasma to a bone substitute was shown in microCT imaging. Autologous, activated platelet-rich plasma combined with hydroxyapatite tricalcium phosphate has a positive effect on the remodeling of the newly formed bone tissue, increasing its density.

Autologous activated platelet-rich plasma (PRP) in bone tissue healing - does it work? Assessment of PRP effect on bone defect healing in animal models.

INTRODUCTION: Platelet-rich plasma (PRP) preparations can be used in bone tissue healing but there are numerous doubts among clinical orthopedists about effectiveness of this method. MATERIALS AND METHODS: The studies were carried out in 12 rabbits of white termond breed. In operating room we operationally generated cylindrical, unicortical defects of the diameter of 4 mm in the middle of the shafts of both femurs. The defects in the left bones were left without filling and served as controls, and 0.7 ml of the ready-to-use PRP was administered to the defects in the right bones (experimental group). We evaluated the usefulness of the diagnostic methods applied: biomechanical tests, micro-CT tests, densitometry, typical radiology, macroscopic measurements, histopathological examinations. RESULTS: The macroscopic measurements showed a statistically significant increase in the dimension in the area of the right defect filled with PRP in relation to the control group. In experimented group, the assessment of the X-ray images showed the formation of a callus cuff around the defects. Densitometric examinations showed no statistically significant differences between defects in the experimental and control group. The analysis of the micro-CT examina- tions showed an increase in the total volume of the tissue examined (Vb) and the low density tissue fraction (Vb2) in the experimental group. The biomechanical examinations revealed signi- ficant decrease in the maximum breaking force (F max) necessary to break the bone in the experi- mental group in relation to the control group. CONCLUSIONS: Platelet-rich plasma (PRP) stimulates bone formation in the area of bone defects and may accelerate bone regeneration.

The use of osteochondral allograft with bone marrow-derived mesenchymal cells and hinge joint distraction in the treatment of post-collapse stage of osteonecrosis of the femoral head.

Osteonecrosis of the femoral head is an entity which occurs mainly in young and active patients aged between 20 and 50. The success of hip joint preserving treatments ranges from 15% to 50% depending on the stage and amount of osteonecrotic lesion. Total hip replacement is indicated in late post-collapse hips but it has unsatisfactory survival because of the wear and osteolysis in young and active patients. Osteochondral allografts have been reported in the treatment of large articular lesions with defects in underlying bone in knee, talus and shoulder. By combining osteoconductive properties of osteochondral allograft with osteogenic abilities of bone marrow-derived mesenchymal cells it has a potential to be an alternative to an autologous graft. The adjunct of hinged joint distraction should minimize stresses in subchondral bone to promote creeping substitution and prevent femoral head collapse. Unlike current treatment modalities, it would provide both structural support and allow bony and articular substitution.

Treatment of Achilles tendinopathy with platelet-rich plasma.

Non-insertional Achilles tendinopathy commonly impedes the functioning of active persons. Treatment methods vary, as do their results. The aim of the study was to evaluate the effectiveness of non-insertional Achilles tendinopathy treatment with autologous platelet-rich plasma (PRP). Autologous PRP was injected into the affected Achilles tendon of 14 prospectively selected patients (15 Achilles tendons). Before PRP administration, all patients were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) scale for the hind foot, and the Victorian Institute of Sport Assessment - Achilles (VISA-A) scale. Ultrasonography (US) and Power-Doppler ultrasonography (PDUS) of the area was also performed. Identical physical and imaging evaluations were performed at 6 weeks, and at 3, 6, and 18 months after injection. During follow up, a significant improvement was observed in the clinical and imaging results. The AOFAS scale improved from a baseline median of 55 points to 96 points at 18 months (p=0.000655), while the VISA-A scale improved from a baseline of 24 to 96 (p=0.000655) in the final evaluations. During the final evaluation, one subject experienced minor pain following prolonged daily activity, while another subject complained of pain following overloading activity. Local, accurate PRP administration improved symptoms of non-insertional Achilles tendinopathy.

[Postero-medial release in surgical treatment of congenital clubfeet: a comment to Turco's method based on personal experience]. / Leczenie operacyjne wrodzonej stopy konsko-szpotawej technika uwolnienia tylno-przysrodkowego--odniesienie do metody turco na podstawie wlasnych obserwacji.

Complete correction of congenital clubfeet by conservative treatment is often impossible. Surgical treatment plays a major role in treatment of this deformity. At the Department of Pediatric Orthopedics in Lublin between 1970 and 1999 1041 children (1253 feet) were treated surgically with Turco's method, in the authors' own modification. The paper presents the technically optimal procedure, the range of tendon elongation. The way the wound is closed is particularly stressed, as well as the need to achieve muscle balance, along with a description of proper post-op care. The material was analysed as a whole, although particular attention was given to three periods: 1970-1975, 1980-1985, 1990-1995. The results were assessed according to the Turco classification, the Magone classification in accordance with the injunctions of the Scientific Committee Meeting of the Pediatric Section of the Polish Orthopedic Society held in Poznan. Good and very good results were achieved in 65-67% of the cases, while satisfactory and bad results were found in 23-30% of the cases.

Tests for the toxicity assessment of cyanobacterial bloom samples.

Cyanobacterial (blue-green algal) blooms are one of the common consequences of the increasing eutrophication of surface waters. The production of cyanobacterial toxins and their presence in drinking and recreational waters represents a growing danger to human and animal health. Due to a lack of toxin standards and to resource limitations on the wide-scale use of analytical methods (e.g., high-performance liquid chromatography, enzyme-linked immunosorbent assay (ELISA)) in cyanobacterial toxin monitoring, it is necessary to assess and to develop additional methods for their detection and estimation. Microbiotests using invertebrates offer a possible approach for the inexpensive and straightforward detection and assessment of cyanobacterial bloom toxicity. Three microbiotests with: Thamnocephalus platyurus, Daphnia magna, and Spirostomum ambiguum were examined with bloom samples containing hepatotoxic microcystin-LR and up to five additional microcystin variants. Two kinds of cyanobacterial bloom sample preparations were tested: crude extracts (CE) and purified extracts (PE). The highest toxicity was found when CE was used for microbiotests. The sensitivity of microorganisms decreased from S. ambiguum to T. platyurus and to D. magna. A statistically significant correlation was found between microcystin concentration and T. platyurus biotest, and between mouse bioassay and S. ambiguum results. Addition of Me2SO (1%, v/v) is a possible method to increase the sensitivity of the microorganisms for microcystin-LR.

Apoptotic effect of cyanobacterial extract on rat hepatocytes and human lymphocytes.

Toxic cyanobacterial blooms are an increasing problem in Poland. The production of cyanobacterial toxins and their presence in drinking and recreational waters represent a growing danger to human and animal health. This is connected with the increase of cyanobacterial biomass caused by excessive eutrophication of the water ecosystem. There is evidence that cyanobacterial hepatotoxins can act as a potent promoter of primary liver cancer. The apoptotic effect of microcystins in Polish cyanobacterial bloom samples on rat hepatocytes and human lymphocytes was observed using light and fluorescence microscopy, flow cytometry, and electrophoretic analysis. The incubation time needed to observe the first morphological apoptotic changes in hepatocytes was approximately 30 min; however, the characteristic biochemical changes in DNA were not observed even after 120 min. In lymphocyte cultures the morphological changes characteristic for apoptosis were observed after 24 h of incubation and a 48-h incubation was found to be optimal for analysis of internucleosomal DNA fragmentation, which is one of the main biochemical hallmarks of programmed cell death. These cells are an easily isolated and inexpensive material for medical diagnostics. Therefore the apoptotic changes, together with the clastogenic effect seen in lymphocyte cultures, are proposed as a future analytical method for these toxins.

Apoptotic effect of cyanobacterial blooms collected from Polish water reservoirs.

Recently in many countries, including Poland, the problem of toxicity of cyanobacterial blooms has been of great importance. In many cases it is connected with the increase of microcystins (MCYSTs) concentration in fresh water. This problem is caused by excessive eutrophication of drinking and recreational water bodies. In humans, the most frequent symptoms of the MCYST effect are: cutaneous rash, fever, vomiting, diarrhoea, gastroenteritis and acute damage of the liver. The aim of this work was to estimate apoptotic effects of five different cyanobacterial hepatotoxic extracts containing MC-LR and other variants of MCYSTs (MC-RR, MC-YR, and MC-WR). These effects were analysed in rat hepatocytes--primary target of cyanobacterial hepatotoxins. Morphological changes in hepatocytes were examined by means of fluorescence and differential interference contrast microscopy with the DNA-specific dye, Hoechst 33342. The hepatocytes were treated with each cyanobacterial extracts containing MC-LR in the range between 100 nM-2000 nM for 30 min, 60 min and 120 min. The first characteristic apoptotic changes: shrinking and budding of cells were seen after 30 min, MC-LR = 100 nM. During the next 30 min the percentage of apoptotic cells increased by over 50%, MC-LR at concentrations ranging from 100 to 250 nM (the value dependent on a bloom sample). Highly condensed chromatin and apoptotic bodies were observed in 85-90% of hepatocytes after 120 min of treatment with MC-LR in concentration of 1000 nM. The apoptotic changes in rat hepatocytes confirm the high cytotoxic potential of cyanobacterial bloom samples collected during different months and years from reservoirs of drinking and recreational water in central Poland.

[Personality changes in children treated by the Ilizarov device]. / Zmiany osobowosci u dzieci leczonych aparatem Ilizarowa.

The treatment of children and youth by Ilizarov's method is very long. During this treatment there appear psychological problems which, on the one hand, are the effects of the features of personality but, on the other hand, they are the effects of emotional lability which is characteristic of adolescence. This paper basing on analysis of questionnaires and chosen personality features attempts to find correlation between these features and the effects of treatment. The obtained findings suggest that patients who are treated by Ilizarov's method should undergo psychological therapy.

[Hip dislocation in children with cerebral palsy--the result of illness or treatment error]. / Zwichniecie biodra u dzieci z mózgowym porazeniem--wylaczny skutek choroby czy takze wynik bledów leczenia.

The authors inform about dangerous complications in the children with cerebral palsy-secondary dysplasia, subluxation or luxation of the hip. Among 326 children treated in the Orthopaedic Paediatric Department in Lublin in the years 1993-1996, 67 children had problems with hips. Paralytic hip luxation leads to the loss of walking abilities among many children. The operative reconstruction of the hip luxation is very difficult and does not allow the complete rebuilding of the joint.

The effect of calcium on DNA synthesis in pea (Pisus sativus L.) roots after treatment with heavy metals.

Cortex cells of the meristematic (1 mm) and differentiated (7 mm) zones of Pisus sativus L. roots after 144 h culture in distilled water (control), Ca2+ (10(-3) M) and/or Cd2+, Cr3+, Pb2+ solutions (10(-4) M, each) were subject of the present studies. Reductions in the number of nuclei incorporating 3H thymidine was observed in meristem in the presence of Cd2+ and in differentiated zone in Pb2+ treated roots. Intensity of DNA synthesis diminished after Pb2+ treatment but mostly in Cd2+ treated roots, mainly in meristem. Addition of calcium to the metal solutions caused an increase in the number of nuclei witch uptook the radioactive material in both studied root zones. Positive effect of calcium alone was visible also in the differentiated zone. Presence of calcium in the metal solutions caused a marked increase in 3H thymidine incorporation into nuclear DNA in meristem, although neutralizing calcium effect in this root zone was visible only in roots treated with Cr2+ and Pb2+. In the differentiated zone of roots growing in Cd2+ solution, calcium addition stimulated DNA synthesis but the intensity of this process was lower than in control (water).