Pectus excavatum: increase of right ventricular systolic, diastolic, and stroke volumes after surgical repair.

OBJECTIVE: The study was undertaken to assess how a surgical correction of funnel chest modifies right ventricular structure and function. METHODS: Before and 6 months after surgery in 42 patients (27 male and 15 female patients, aged 5-31 years), a pectus index was calculated and echocardiographic examinations of the right ventricle were performed, with calculation of systolic, diastolic, and stroke volume indices. Right ventricular volume was estimated by subtracting the left ventricular volume from that of the entire heart. The values of the right ventricular volumes and the pectus index before and after the operation, as well as the changes in the indices, were compared. RESULTS: Statistically significant changes in the pectus index and the right ventricular volume indices after surgery were noted. No correlation was observed between the changes in the pectus index and the changes in any right ventricular volume indices. CONCLUSION: Surgical treatment of funnel chest causes an increase in right ventricular systolic, diastolic, and stroke volumes, although there is no correlation between these changes and the degree of sternocostal elevation.

Long-term observation in 68 patients operated on for pectus excavatum: surgical repair of funnel chest.

BACKGROUND: Recurrence after correction of pectus excavatum may sometimes occur, but its origin is not clear. The type of deformity, surgical technique, and patient lifestyle after operation can all affect the final shape of the thorax. The purpose of the present study was to compare the short-, medium-, and long-term cosmetic results of funnel chest repair. METHODS: Sixty-eight patients (mean age, 12.1+/-5.4 years; 48 male) were operated on for pectus excavatum using the same surgical technique: subperichondrial resection of the abnormal costal cartilages and stabilization of the elevated anterior chest wall with Kirschner's wires. The patients were followed up every year (1 to 10 years) after operation, and the anterior chest wall contour was checked by physical examination and x-ray film. RESULTS: Excellent to good cosmetic results 1 year after operation were achieved in 66 patients (97.1%). During the later follow-up period, a mild or moderate degree of recurrent sternal depression was noted in 6 patients (8.8%), teenagers only, 3 to 9 years after primary repair. CONCLUSIONS: Our technique for correction of pectus excavatum yields good short-term cosmetic results. Late recurrence of the deformity occurs during pubertal growth and does not appear to depend on surgical technique or length of follow-up.

Free radicals generation by granulocytes from men during bed rest.

Phagocytes (granulocytes and macrophages) are one of the most important sources of reactive oxygen species (ROS) in the human body. A stimulated phagocyte reaches within a dozen of seconds the functional state known as the respiratory burst. This phenomenon includes three interrelated processes: 1) a several fold increase in the oxygen uptake, 2) generation of large amounts of ROS, and 3) stimulations of glucose metabolism via the pentose phosphate shunt. The main ROS generated during phagocytosis is the superoxide radical anion O2-. The reaction of dismutation of O2- generates hydrogen peroxide (H2O2). O2- and H2O2 do not have strong cytocidal proerties but are supbstrates for the generation of more active biologically ROS, especially the hydroxyl radical (OH) and hypochlorous acid (HOCl). A stimulated phagocyte (especially neutrophil) generates also vast amounts of nitric oxide (NO-). NO- may react with the superoxide radical anion forming peroxynitrate (ONOO-). Reactivity of ONOO- is comparable to that of the hydroxyl radical. ONOO- plays probably a very important role in the so-called oxygen-dependent killing mechanisms during phagocytosis. The role of NO- in the process of phagocytosis is unclear. However, NO-, apart from other biological functions, inhibits aggregation and adhesion of blood platelets. Morevover, it seems to participate in the slefregulation of granulocyte cativity (probably limiting excessive inflammative reaction). Excess of ROS generated by phagocytes may damage biologically important macromolecules. Membrane lipids are particularly vulnerable to peroxidation. It leads to alterations in membrane fluidity and permeability. ROS excreted to the environment of a phagocyte may impair functions of other morphotic elements of blood (erythrocytes and thromobcytes) in this way. Bed rest covers two conditions: 1) limitation of motoric activity (hypodynamia) and 2) restraining the pressure on bones along parallelly to their long axes (hypogravia). Under bed rest conditions organism is subject to many harmful changes. I.a., bed rest affects also leukocyte functions. However, we were not aware of any sutdies concerning the effect of bed rest on the respiratory burst of granulocytes. This study was aimed at an examination of the effect of bed rest on the generation of O; and H2O2 by neutrophils (PMNL).

Effect of long term bed rest in men on enzymatic antioxidative defence and lipid peroxidation in erythrocytes.

Bed rest is an integral part of treatment of numerous diseases. Typical examples are bone fractures of lower extremities and pelvis. Temporary immobilization is necessary also, e.g., in heart diseases (stroke), backbone and imminent abortion. The sick organism spares energy during the bed rest wich is beneficial. However, bed rest results in many alterations which are disadavantageous. They concern the function of almost all organs and systems but affect most significantly the locomotor and ciruclatory systems. Bed rest brings also about changes in the composition of peripheral blood and functions of the morphotic elements of blood. Red blood cells are subjected to the action of large amounts of reactive oxygen species (ROS). During oxidation of hemoglobin to methemoglobin superoxide radical anion (O2-) is formed: HbFe2+ + O2 --> MetHbFe3+ + O2- (1) Ferrous and ferric ions present in the cytoplasm of red blood cells may be catalysts of the Fenton reaction leading to the production of the hydroxyl radical: O2- + Fe3+ --> O2- + Fe2+ (2) Fe2+ + H2O2 --> Fe3+ + OH + HO- (3) OH shows a tremendous reactivity. It may react with lipids, proteins, nucleic acids and carbohydrates. The process of lipid peroxidation is best understood. It concerns mainly polyunsaturated fatty acids present in cell membranes. Peroxidation of membrane lipids decreases membrane fluidity and impairs its barrier function. The lowered membrane fluidity compromises erythrocyte deormability which in turn disturbs oxygen delivery to the tissues. End productions of lipid peroxidation are low-molecular wieght compounds, among them carbohydrates (ethane and pentane) and aldehydes, e.g. malondialdehyde (MDA). MDA concentration is an acknowldeged marker of the intensity of lipid peroxidation. Erythrocytes contain a complex system of protection against the action of ROS. It includes various enzymatic and non-enzymatic mechanism. The most important antioxidative enzymes of the red blood cells are superoxide dismutase (Cu,Zn-SOD, EC 1.15.1.1) catalase (CAT, EC 1.11.1.6) and glutathione peroxidase (GSH-Px, EC 1.11.1.9). Cu,Zn-SOD catalyzes the dismuation of O2- to hydrogen peroxide (H2O2). Catalase and peroxidase remove H2O2 and, moreover, GSH-Px can reduce lipid peroxides. Under normal conditions an equilibrium exists between the formation and removal ROS. If ROS are formed in excess or the defensive antioxidative mechanism are inefficient, oxidative stress develops. Derangement of the equilibrium between the formation and removal of ROS is important in the pathosgenesis of many diseases, e.g. atherosclerosis, diabetes, Down syndrome and Alzheimer disease. There are literature data on disturbances of enzymatic antioxidant defense mechanism of blood plateless during bed rest. This study was aimed at an examination of the post-traumatic bed rest on the enzymatic antioxidative defense mechanisms and lipid peroxidation in erythrocytes.

Red blood cell metabolism in men during long term bed rest.

The investigations were carried out on 20 men (aged 32-48), hospitalized after lower extremity fractures, in whom no systemic diseases or disorders were found. The activity of glucose-6-phosphate dehydrogenase (G6P-DH), aldolase (A1), lactate dehydrogenase (LDH) and the concentrations of pyruvate, lactate, nicotinamide-adenine dinucleotide (NAD), nicotinamideadenine dinucleotide phosphate (NADP), adenosine-5'-triphosphate (ATP), adenosine-5'-diphosphate (ADP), adenosine -5'-monophosphate (AMP) and 2,3-diphosphoglycerate (2,3-DPG) in erythrocytes taken from patients were estimated. After a two-week hypokinesia G6P-DH, A1, LDH activities and ATP, ADP, AMP concentrations decreased, whereas other estimated parameters did not differ from the control levels. During a 30-day hypokinesia of patients with fractures of the lower extremity a transient decrease of erythrocyte metabolic activity was observed after two weeks. off

[Effect of correcting funnel chest on respiratory function]. / Wplyw korekcji lejkowatej klatki piersiowej na czynnosc ukladu oddechowego.

The authors discuss the results of pulmonary function tests performed at rest in 25 patients treated for pectus excavatum. Surgical correction of the lesion was performed by resection of the deformed costal cartilages, longitudinal and transversal sternotomy, stabilization of the anterior chest wall with Kirschner wires. Control tests carried out 6 months following the surgical correction. In cases of severe deformation of the chest wall a decrease of pulmonary function indices was evident. Following the surgical correction all spirometric indices increased.

Effect of bed rest on the adenine nucleotides concentration in human blood platelets.

The effect of immobilization in bed on metabolism and function of human blood platelet was studied. Blood platelets taken from patients with bone fractures after long term bed rest (14 days and 28 days) demonstrated significantly reduced concentration of total adenine nucleotides (after 28 days reduction about 30%). This decrease of total platelet adenine nucleotides after immobilization in bed is probably caused by stimulation of platelet secretory process. Thrombin which released from control platelets 58.2% +/- 1.5% of total adenine nucleotides liberated decreased amounts (only 23.1% +/- 3.3% of total) of nucleotides from patient platelets isolated after 28 days of immobilization in bed. Loss of nucleotides from platelets was accompanied by slightly increased extent of platelet aggregation. It is concluded that during bed rest the reactivity of blood platelets (aggregation and release reaction) is stimulated.

[Rhythmic pneumatic compression of the limb as a contributing element of postoperative deep vein thromboembolism prophylaxis in patients after orthopedic surgery]. / Rytmiczny pneumatyczny masaz konczyny jako element skojarzonej profilaktyki zakrzepicy zyl glebokich u chorych po operacjach ortopedycznych.

A combined prophylaxis against postoperative deep venous thrombosis comprising of sequential pneumatic limb compression using RMP I/K apparatus and lysine or dextran 70.000 administration was of applied in 34 patients after total hip arthroplasty. In 14 cases lysine was the drug, dextran was used in remaining ones. Prophylaxis was evaluated by impedance plethysmography. No case of postoperative deep venous thrombosis was reported.

[Results of treating pseudarthrosis and leg bone defects caused by osteitis]. / Wyniki leczenia stawów rzekomych i pozapalnych ubytków kosci goleni.

The results of treatment of 17 patients--8 cases of leg bones defect due to osteitis and 9 cases of leg pseudoarthrosis has been presented. The osteosynthesis of the fragments was done with the use of Zespol fixator. In 14 patients the lesion has healed and satisfactory function of the extremity was restored.

[Modified Ravitch operation in the treatment of patients with funnel chest]. / Zmodyfikowana operacja Ravitcha w leczeniu chorych z szewska klatka piersiowa.

The characteristic traits of funnel chest have been presented and the clinical results of surgical treatment in 13 patients by the modified Ravitch method have been discussed. Nine results were excellent and four results were good. A marked improvement of general physical function of the patients due to the increase of respiratory system efficiency and a good cosmetic effect were found. The modification of the operation consists in additional longitudinal osteotomy of the sternum, suturing of the manubrium to the sternum shaft, non-suturing of the rib cartilages after resection, filling of the through-like groove in the reposited sternum with the fragments of the resected rib cartilages, and immobilization of the fragments of the longitudinally osteotomized sternum that are inserted crosswise with several (usually three) Kirschner wires, based on the thorax.

[Results of the treatment of femoral shaft fractures]. / Wyniki leczenia zlaman trzonu kosci udowej.

The treatment results of 141 femoral bone fractures, including 29 complicated fractures, have been presented. The most frequent cause of femoral shaft fracture was traffic accident (71.6 per cent of the cases). The best results were obtained in the patients treated by the functional method; the worst results were obtained in the group treated surgically by adaptive osteosynthesis with the use of a metal plate and screws. In sum, excellent and good results were obtained in 70.2 per cent, fair in 19.1 per cent, and poor in 10.7 per cent of the cases.

[Complications in the treatment of femoral shaft fractures]. / Powiklania w leczeniu zlaman trzonu kosci udowej.

Early and late complications of the treatment of 141 cases of femoral shaft fracture by various methods have been presented. The most frequent early complications were various forms of traumatic shock (ca. 28 per cent). Disturbances in bone union and infections were main late complications of femoral shaft fracture. Lack of bone union occurred in 7.8 per cent of the cases. Posttraumatic ostitis occurred in 4.9 per cent of the cases.