Duplicated superficial branch of the radial nerve and brachioradialis muscle belly: prevalence and significance.

BACKGROUND: The superficial branch of the radial nerve (SBRN) is a sensory nerve innervating the dorsoradial part of the hand. It originates in the cubital fossa, runs under the belly of the brachioradialis muscle (BM), emerges from underneath in the distal third of the forearm and continues in the subcutaneous tissue towards the hand. There exist several anatomical variations of its branching and course, including a rare variation of its duplication combined with a duplication of the brachioradialis muscle belly. The aim of this study was to find out the prevalence of this variation on a sample of cadaveric human bodies which has not been reported yet. MATERIALS AND METHODS: We have carefully dissected 208 cadaveric upper limbs (Central European population). All cases of limbs containing the variation of a double SBRN and/or a double BM belly were measured and documented. RESULTS: We have identified 2 cases of a double SBRN combined with a double BM belly (0.96%). Both were present in the right forearm of a male donor and in both cases the nerve was impinged by muscle bundles connecting the 2 muscle bellies together. Moreover, we have encountered 1 case of a double SBRN without a double BM belly (0.48%), i.e. the total prevalence of a double SBRN was 1.44%. CONCLUSIONS: The duplicated SBRN with the duplicated BM is a relatively rare anatomical variation that might cause complications while performing various surgical procedures in the forearm, moreover it might be a rare cause of Wartenberg's syndrome.

[The Injury-Treatment Time Interval of the Most Frequent Limb Fractures - 1-Year Monocentric Study]. / Interval úraz-osetrení u nejcastejsích zlomenin skeletu koncetin ­ jednoletá monocentrická studie.

INTRODUCTION The purpose of the study was to evaluate the injury-treatment time interval in a group of patients with limb bone fractures over the period of one year; and to compare this interval in the most frequent fractures of the upper and lower limb. MATERIAL AND METHODS The followed-up group of the prospective one-year monocentric study included 3,148 patients treated consecutively for 3,909 fractures. For the purpose of sub-analysis of the injury-treatment time interval in limb bone fractures, excluded from the group were the patients with multiple fractures (520 pts), patients with spinal fractures (356 pts) and pelvic fractures (210 pts). The statistical significance of the achieved results was tested with the use of contingency tables (chi-square test of independence). The significance level for the quantified tests was set at 5%. RESULTS The sub-analysis covered 1,727 patients whose medical records mentioned the exact time of injury and first examination. Within the first 6 hours after the injury, 536 (56.0%) patients with an upper limb bone fracture and 429 (55.7%) patients with a lower limb bone fracture were treated. Within 24 hours after the injury, 683 (71.4%) patients with an upper limb bone fracture and 572 (74.3%) patients with a lower limb bone fracture were treated. Within the first 24 hours after the injury, 104 (76.4%) patients with a proximal humerus fracture, 240 (84.5%) patients with a distal radius fracture and only 174 (55.5%) patients with metacarpal and phalanx fractures were treated. In the first hours after the injury, most frequently treated were the patients who sustained a distal radius fracture, and the longest injurytreatment time interval was seen in patients with hand bone fractures. The difference in the 24hour injury-treatment interval was significant when comparing distal radius fractures and proximal humerus fractures (p = 0.047) and when comparing distal radius fractures and hand bone fractures (p < 0.001). Within 24 hours after the injury, 166 (83.3%) patients with a proximal humerus fracture, 128 (79.1%) patients with an ankle fracture and 142 (63.4%) patients with metatarsal and phalanx fractures were treated. The shortest injury-treatment interval was reported in patients with a proximal femoral fracture and an ankle fracture, and relatively the lowest number of treated patients in the first hours after the injury was reported among patients with metatarsal and toe fractures. When evaluating the 24hour injury-treatment time interval, this difference was significant only when comparing proximal femoral fractures and metatarsal and phalanx fractures (p < 0.001), while when comparing proximal femoral fractures and ankle fractures the difference was not significant (p = 0.283). DISCUSSION There are not many studies of other authors focused on monitoring the injury-treatment time interval in the most frequent limb bone fractures. They also confirm that the treatment is sought out most quickly by patients with fractures that make walking or self-care impossible. CONCLUSIONS The results of the study confirmed that the fastest treatment was requested in patients with fractures which made the selfcare (distal radius) or walking (proximal femur, ankle) impossible; less painful fractures (metacarpal, phalanx fractures) and fractures that do not compromise walking (metatarsal fractures) were treated in the first 24 hours after the injury significantly less frequently. The patients with ankle fractures sought out treatment the most quickly compared to the patients with other fractures; it concerned largely occupational or sports injuries sustained by young men who were brought for treatment immediately after the injury, directly from their workplace or sports ground. The treatment of osteoporotic fractures (proximal humerus, distal radius, proximal femur) was spread over the first 6 hours due to the lack of independence of elderly patients after sustaining a fall at home; in majority of them transport to treatment was arranged for by relatives or neighbours only with a certain delay, once they became aware of their injury. Key words: fracture epidemiology, limb bone fractures, trauma-treatment time interval.

Influence of Polysaccharides' Molecular Structure on the Antibacterial Activity and Cytotoxicity of Green Synthesized Composites Based on Silver Nanoparticles and Carboxymethyl-Cellulose.

In this paper we report on the influence of polysaccharides' molecular structure on the antibacterial activity and cytotoxicity of composites based on silver nanoparticles (AgNPs) immobilized into carboxymethyl-cellulose (CMC). These composites were green synthesized from the reduction of silver ions into aqueous solutions of the polysaccharide, using CMC with different degree of substitution (DS) and molecular weight (Mw). The composites were characterized by transmission electron microscopy (TEM), as well as infrared (ATR-FTIR), ultraviolet (UV-Vis), Raman, and X-ray photo-electron (XPS) spectroscopic techniques. The antibacterial activity was evaluated with minimum inhibitory concentration against Enterococcus faecalis. The cytotoxicity of composites was assessed against human gingival fibroblast. Experimental evidence suggests that particle size distribution and morphology of AgNPs change according to the quantity of silver precursor added to the reaction, as well as the DS and Mw of CMC used for composites preparation. This is related to the dispersion of silver precursor into aqueous solutions of the polysaccharide and the formation of Ag-O coordination bonds among AgNPs and COO- moieties of CMC. Moreover, these coordination bonds modify the ability of nanoparticles to produce and release Ag+ into aqueous dispersion, adjusting their antibacterial activity and the induction of cytotoxicity into the tested biological environments.

Arterial supply of the thumb: Systemic review.

We offer a complete systemic review of the anatomy of arteries of the thumb, including their sources in the first web space. Eleven studies were selected from the PubMed, Medline, Embase, Scopus and Ovid databases. Data about each artery of the thumb were obtained; in particular, the incidence and dominance of each of these arteries were calculated. The ulnopalmar digital artery of the thumb (UPDAT) was found in 99.63%, the radiopalmar digital artery of the thumb (RPDAT) in 99.26%, the ulnodorsal digital artery of the thumb (UDDAT) in 83.39%, and the radiodorsal digital artery of the thumb (RDDAT) in 70.38%. The sources for the thumb arteries are the first palmar metacarpal artery (for UPDAT in 63.15%, for RPDAT in 78.88%, for UDDAT in 56.95% and for RDDAT in 41.48%), the first dorsal metacarpal artery (for UPDAT in 20.54%, for RPDAT 2.53%, for UDDAT in 20.62%, and for RDDAT in 4.81%) and the superficial palmar arch, either complete or incomplete (for UPDAT in 25.57%, for RPDAT in 23.04%, for UDDAT in 0%, and for RDDAT in 5.19%). The dominant source could be identified in 88.2% of cases: the first palmar metacarpal artery (66.2%), the first dorsal metacarpal artery (15.5%) and the superficial palmar arch, complete or incomplete (8.2%). Four arteries usually supply the thumb. Any artery in the first web space can be a source for the thumb arteries. We propose a new classification of the arteries of the hand, dividing them into three systems (superficial palmar, deep palmar and dorsal system), and suggest that the term "princeps pollicis artery" be reconsidered and systemic anatomical terms of the thumb arteries preferred. Clin. Anat. 30:963-973, 2017. ©2017 Wiley-Liss, Inc.

A plea for extension of the anatomical nomenclature. Part 1: Nervous system and senses.

A correct, exact, concise and detailed anatomical nomenclature is a cornerstone of communication not only in anatomy and related subjects but also in other medical branches and in the whole medical education. Terminologia Anatomica fulfils this task but some important structures are still missing there. The authors have collected and present here a list of terms including their definitions or explanations to provoke discussion about possible extension of the Terminologia Anatomica. The first part of this contribution, presented in this article, comprises 113 terms concerning the regulation systems of the human body: endocrine glands, central and peripheral nervous system, and senses. It also contains some corrections of anatomical mistakes, systemic inconsistencies and grammar changes.

[Infectious Inflammation of Pubic Symphysis (Symphysitis Pubis Purulenta): Five Case Reports and Literature View]. / Infekcní zánet symfýzy (symphysitis pubis purulenta): pet kazuistik a prehled literatury.

Purulent inflammation of the pubic symphysis is a rare condition involving the symphysis and parasymphyseal parts of the pubic bones. It is usually found in immuno-compromised patients and its most frequent cause is Staphylococcus aureus. Conservative treatment is based on long-term administration of antibiotics and has been efficient, as reported, in about 50% of the patients. The authors treated five patients with a late diagnosis of purulent infection of the pubic symphysis in whom the antibiotic therapy had to be completed by surgical intervention. Three patients undergoing surgery with removal of the infected necrotic tissue healed fast and well. One patient required repeated surgery because of recurrent purulency; eventually, the infection cleared up. One patient was treated only conservatively because she refused surgical treatment. Consequently, pubic diastasis developed and she suffered from persistent pelvic pain. One year after treatment her condition became complicated by pelvic fracture following a fall. The patient refused surgery again. However, the development of non-union and progression of complaints made her agree to a surgical treatment; fixation of the non-union had a satisfactory outcome. In the literature, infection in the symphysis region is referred to by several different names. One - in the authors' opinion incorrect use - is "arthritis" (septic arthritis of the pubic symphysis; pubic symphysis septic arthritis; infectious osteoarthritis of the pubis). Another term is "osteomyelitis" (acute pubic osteomyelitis; pubic osteomyelitis; osteomyelitis of the pubis; osteomyelitis pubis; osteomyelitis of the pubic symphysis; osteomyelitis of the symphysis pubis). None of the names shows clearly whether it is primary an infection of the symphysis or of the parasymphyseal bone. A combination of the term "osteitis" with "infectious" (infectious osteitis pubis) is an attempt to distinguish purulent symphysitis pubis from osteitis pubis. The authors completed both the Czech and English title of this paper with the Latin designation symphysis pubis purulenta. A possibility of using a new name, such as "pubosymphysitis", in analogy to "spondylodiscitis" can also be discussed. However, the use of simple terms "infection of symphysis" or "infection of pubic symphysis" seems to be most practicable. Based on the experience with the treatment of five patients with infection of the pubic symphysis, the authors suggest that the late phase with abscess formation or purulent discharge should be managed by surgery. This treatment has good clinical outcomes although it may be complicated by slow healing of soft tissues around the symphysis and instability of the anterior pelvic segment with its sequelae. Key words: infection of the symphysis, infection of the pubic symphysis, septic arthritis of the pubic symphysis, pubic osteomyelitis.

[Minimal Invasive Fixation of Pelvic Injury: CT-Study of the Pelvic Bone Dimensions]. / Miniinvazivní osteosyntéza poranení pánve: CT studie rozmeru skeletu pánve.

UNLABELLED: PURPOSE OF THE STUDY This radiographic study was focused on measuring the dimensions of pelvic bones at sites of minimally invasive screw insertion with the aim to assess the risk of damage to vascular and nervous structures. MATERIAL AND METHODS The group consisted of 77 patients (39 women and 38 men) aged between 19 and 85 years (average, 65; women, 65; men, 64) who underwent CT examination of the pelvis because of reasons other than injury. On the left side, a total of 14 dimensions of the superior pubic ramus, supraacetabular region, retroacetabular region, quadrilateral surface of the acetabulum and lateral foraminal sides of the S1 and S2 vertebral bodies were measured. The results were evaluated using descriptive statistics. RESULTS The inner antero-posterior dimension of the isthmic area of the superior pubic ramus was 8 mm or less in four women (10.3%) and 9 or 10 mm in further 14 women (35.9%). The inner cranio-caudal dimension of the superior pubic ramus was 8 mm or less in 14 women (35.9%) and 9 or 10 mm in further 16 women (41.0%). These dimensions obtained in men were as follows: 8 mm and less in three men (7.9%) (7 mm in one, 8 mm in two), and 9 or 10 mm in nine men. Sizes of the other pelvic bones were large enough to allow for safe insertion of single screws. DISCUSSION Single screws most frequently used in minimally invasive treatment of pelvic fractures are cannulated screws 7.3 mm or 6.5 mm in diameter; less frequently used are 4.5-mm cancellous screws (e.g. in treatment of avulsion injuries) or long 3.5-mm cortical "creeping" screws to be inserted in the superior pubic ramus. The use of "creeping" screws reported by several authors indicates problems associated with placement of standard screws (diameter, 7.3 mm and 6.5 mm) through the isthmus into the superior ramus. In slim high pelvises of some patients with gracile skeletons or in low pelvises of small women, the screws can protrude over the cortical margin. However, the risk of injury to nervous or vascular structures is low when the intraosseous screw is exactly inserted and it is so even in case its thread cuts into cortical bone. Neither the femoral artery nor the femoral nerve is situated too close to the superior pubic ramus. The "corona mortis" may potentially be jeopardised because of its contact with both the superior and posterior cortical bones of the superior ramus, but it usually follows a course more lateral to the isthmus of the ramus. CONCLUSIONS The results of the study showed that the size of the superior pubic ramus in its isthmic area may cause difficulties during insertion of cannulated screws with standard diameters (7.3 mm and 6.5 mm) in the majority of women and in some men. The risk of damage to vascular and nervous structures during screw insertion is associated only with the superior and posterior walls of the superior pubic ramus and with the area of the S2 foramen in case the correct procedure of intraosseous screw insertion is not strictly followed. KEY WORDS: retrograde pubic screw, iliosacral screw, supraacetabular screw, retrograde posterior column screw.

[Risk of death in patients with unstable pelvic fracture and large vessel injury]. / Riziko úmrtí pacienta s nestabilní zlomeninou pánve a poranením velkých cév.

INTRODUCTION: The aim of the study was to provide accurate data regarding the incidence of large vessel injury as part of pelvic trauma in patients treated during a 12-year period. METHODS: In total, 715 patients admitted and treated for pelvic fractures from 2001-2012 were analyzed. Data on large vessel injuries (aorta, inferior vena cava, common iliac artery and vein) reported in perioperative or autopsy findings were obtained from the patient database. The statistical significance of achieved results was tested using contingency tables (chi-square test of independence or Fisher factorial test). The significance level for the calculated tests was chosen to be 5%. RESULTS: Sixty six (9%) patients died in the first hours after admission, 43 (6%) of them prior to surgery. Seventy (10%) underwent urgent surgeries, 47 (7%) of whom survived and 23 (3%) died. A large vessel injury in the pelvic region was detected in 13 (2%) patients. In the surviving surgical patients, a serious injury of pelvic venous plexus, as the only source of bleeding, was found only once (2%), while in patients who deceased post-surgically and pre-surgically, serious vascular injury in the pelvic region was diagnosed in 5 and 7 patients in both subgroups (22% and 41%, resp.). This difference was significantly higher in comparison with surviving patients (p=0.0002 and p=0.0109, resp.). CONCLUSION: The incidence of large vessel injury with severe bleeding associated with pelvic trauma was low in our study; however, the risk of death in patients with this injury was significantly higher. The results of our study support the hypothesis that in most patients a large artery or vein injury in combination with massive bleeding from the venous plexus due to a dislocated pelvic fracture results in death even before arrival of emergency services. This hypothesis could be verified in a study including also autopsy findings in persons who died even before hospital admission. KEY WORDS: unstable pelvic injury vascular injury risk of death.

[Perilunátní poskození zápestí]. / Perilunátní poskození zápestí.

PURPOSE OF THE STUDY Perilunate dislocations and perilunate fractures are serious wrist injuries which are often overlooked at primary treatment. Their inadequate therapy results in severe wrist damage and patient disability. An early diagnosis and correct therapy can prevent such conditions. MATERIAL AND METHODS A group of 25 patients with 26 wrist injuries is presented. It included nine patients with isolated perilunate dislocations (34%), 11 patients with trans-scaphoid perilunate dislocations (44%),two with trans-radial trans-scaphoid perilunate dislocations (7%) and next two patients with trans-radial perilunate dislocations (7%). One patients had, in addition to perilunate dislocation, injury to the capitohamat joint with damage to both portions of the interosseous ligament (4%). One patient (4%) sustained a trans-scaphoid perilunate dislocation with injury to the scapholunate ligament, in which the proximal pole of the scaphoid was separated and interfered with dislocation reduction. RESULTS The correct diagnosis was made on early examination in 16 patients (62%), within a week of injury in four patients (15%), within a months of injury in two patients (8%) and even later in four patients (15%). The results of treatment evaluation based on the Wrightington Hospital Wrist Scoring System were excellent in 19%, good in 54%, satisfactory in 19% and poor in 8% of the patients. The poor result in one patient was due to necrosis of the lunate bone;the diagnosis of a perilunate dislocation was made within a month of injury. The poor results in the other patient were associated with complex regional pain syndrome. DISCUSSION Perilunate injuries of the wrist are quite frequent and although the treatment procedure is commonly known, its principles are not always obeyed. A good outcome is related to an early diagnosis and correct reconstruction of the injured structures. In our group, the diagnosis was made at the first examination in only 62% of patients and later than a week after injury in 23%. The patient in whom necrosis of the lunate bone developed had the diagnosis made at 1 post-injury month. Early reduction of bone structures and reconstruction of ligaments also contribute to good results. CONCLUSIONS Good outcomes in perilunate injuries depend on an early and correct diagnosis, an appropriate therapeutic procedure and an orthopaedic surgeon who has experience with management of such injuries. A deep knowledge of wrist kinetics is necessary for this therapy as not all injuries happen according to textbook descriptions. Key words: perilunate dislocation, carpal instability, damage to carpal ligaments.

[Kirschner wire transfixation of unstable ankle fractures: indication, surgical technique and outcomes]. / Transfixace nestabilních zlomenin hlezna Kirschnerovými dráty: indikace, technika provedení a výsledky.

PURPOSE OF THE STUDY The aim of the study was to assess treatment outcomes in patients undergoing K-wire transfixation of unstable ankle fractures and compare the results with those of patients in whom it was possible to perform primary one-stage osteosynthesis. MATERIAL AND METHODS Between 2009 and 2012, a total of 358 patients (191 women and 167 men) had surgery for unstable ankle fracture. At 1-year follow-up, their subjective feelings, objective findings and ankle radiographs were evaluated. The fractures were categorised according to the Weber classification. A patient group treated by one-stage osteosynthesis, a group with definitive transfixation and a group of patients in whom temporary transfixation was converted to definitive osteosynthesis were assessed and compared. RESULTS The group treated by one-stage osteosynthesis included 278 patients with an average age of 47 years; the group of 20 patients with definitive transfixation had an average age of 67 years, and the group of 60 patients who had temporary transfixation with subsequent conversion to internal osteosynthesis were 55 years on average. In the group with one-stage osteosynthesis, 223 (80%) ankle fractures on post-injury radiographs were associated with minor joint dislocations and 55 (20%) with major dislocations. On the other hand, the radiographs of the patients treated by temporary transfixation and delayed open reduction with internal fixation showed major dislocations in 38 (63%) and minor dislocations in the rest of the patients (37%); the difference between the two groups was statistically significant (p<0.001). Posterior malleolar fractures were most frequent in the group with temporary transfixation (60%) and least frequent in the group with primary osteosynthesis (44%); also this difference was statistically significant (p=0.032). At one-year follow-up, in the group with one-stage osteosynthesis, 220 patients (79%) had no radiographic signs of posttraumatic ankle osteoarthritis while, in the group with temporary transfixation, no radiographic evidence of ankle osteoarthritis was recorded in 25 (42%) patients. While tibiofibular synostosis was recorded in only few patients (9%) of the group with one-stage osteosynthesis, it showed a high occurrence in the group with temporary transfixation (35%). The patients with one-stage osteosynthesis (188/68%) had a higher proportion of excellent outcomes measured on the Olerund-Molander ankle scoring scale than the other two groups (temporary transfixation, 47%; definitive transfixation,10%); in both cases the difference was significant (p < 0.001 and p = 0.003, respectively). DISCUSSION In this study the morphological and clinical aspects of surgically treated ankle fractures were assessed. The patients with one-stage osteosynthesis were compared with those treated by temporary or definitive transfixation. The majority of patients undergoing temporary transfixation had a fractured posterior margin of the tibia and major ankle joint dislocation, which suggested serious injuries to bone and ligament structures. Generally, the use of only two K-wires inserted through the calcaneus and talus into the distal tibia is recommended. Patients with K-wire transfixation usually require a longer hospital stay because of the serious nature of their injuries. CONCLUSIONS The therapy of choice for unstable ankle fractures is one-stage osteosynthesis. Temporary transfixation is an effective method of primary management when an unstable fracture cannot be treated by definitive osteosynthesis at the early stage due to local or general health conditions of the patient. The temporary transfixation provides good alignment of the ankle joint necessary for successful healing of soft tissues. A higher occurrence of post-traumatic ankle osteoarthritis, ossification and distal tibiotalar synostosis found in the patients treated by temporary transfixation is more related to serious types of ankle fractures the patient had suffered than to the method itself. Key words: unstable ankle fracture, soft tissue condition, indications for transfixation, treatment outcome.

Assessment of complications depending on the sliding screw position - finite element method analysis.

OBJECTIVES: The study was aimed at the assessment of specific complications depending on the sliding hip screw position. BACKGROUND: The finite element method in the biomechanical analysis of this implant may be used to predict the mechanical failure due to the screw position. METHODS: 380 sliding screw osteosyntheses for stable pertrochanteric fractures of 365 patients were included in the study. We divided and analysed the osteosyntheses with five various screw positions and focused on the specific complications development. For the construction of the finite element model of the femur, the program ABAQUS 6.9 was used. Analyses were performed with evaluation of the bone response to the different screw locations (strain and stress) with maximum low-cycle high stress loading. RESULTS: The specific complication rate was 10 %, with the re-operation rate of 4.2 %. If placing the screw in the middle third of the neck it reduced significantly strain patterns of the plate and screw. A screw position in the superior third of the neck significantly increased the strain of the plate and screw by more than 63 %. CONCLUSIONS: The conformity in the clinical and biomechanical analyses was observed. The finite element model can be considered as valid in predicting sliding screw failures (Tab. 4, Fig. 8, Ref. 30).

[Risk of bleeding from the internal iliac artery and its branches in pelvic fractures: cadaver study]. / Riziko krvácení z arteria iliaca interna a jejích vetví pri zlomeninách pánve: kadaverózní studie.

PURPOSE OF THE STUDY: The study was designed to investigate whether anatomical variations of the anterior and posterior divisions of the internal iliac artery and their branches are associated with different risks of bleeding resulting from injury to the posterior pelvic segment. MATERIAL AND METHODS: The study was carried out on 19 cadavers. The dissected area included the internal iliac artery from the common iliac artery bifurcation to the origins of the superior gluteal artery, the inferior gluteal artery and the internal pudendal artery. Using an electronic slide rule, distances between the bifurcation and the origin of each branch from either the anterior or the posterior division were measured. The diameter of each vessel was also determined. Findings of the study were compared with variations described in the literature. The degree of risk for bleeding related to different anatomical variations of the internal iliac artery and its branches was evaluated based on the proximity to the bone. RESULTS: There are six anatomical variations of internal iliac artery branches. Four of them were found: type A1 was recorded in 10 specimens, type A2 in six, type B1 in two and type C in one specimen. Types B2 and D were not seen. DISCUSSION: The type B2 and C anatomical variations were considered to carry higher risks of bleeding due to injury to the posterior pelvic segment. These variations are characterized by vessels larger in diameter and a longer course of the posterior division along the posterior part of the greater sciatic notch (area often involved in unstable pelvic ring fractures). On the other hand, the type C variation showed a longer internal iliac artery separated from the bone with a thick layer of soft tissue, which suggested lower risk than was attributed to the dominant type A1 variation. It was not possible to evaluate type B2 variation because it is very rare and was not found in study material. In type A2 and B1 variations, the branches were separated from bony structures similarly to the dominant type A1 variation. CONCLUSIONS: The cadaver study designed to assess the risk of bleeding associated with different morphological variations of the branching pattern of the internal iliac artery did not identify any anatomical arrangement that might carry a higher risk of injury to the vessels by free bone fragments of the posterior segment in unstable pelvic fractures. It can be concluded that less common branching patterns of the internal iliac artery are not associated with higher risk of bleeding than the dominant type A1 variation.

Oxygen non-stoichiometry phenomena in Pr1-xZrxO2-y compounds (0.02 < x < 0.5).

New Pr1-xZrxO2-y oxides with x < 0.5 have been prepared by co-precipitation in basic medium and annealed under air at high temperatures (T≤ 1200 °C). Defined compositions with x = 0.02, 0.1, 0.2, 0.35, 0.40 and 0.5 have been characterized by XRD, Zr-K-edge EXAFS for the local structure, magnetic susceptibility measurements, and Pr LIII-edge XANES in order to identify the variation of the cell parameter and Zr local environment versus Zr content and Pr(n+) (4 < n < 3) oxidation states. The higher the Zr content, the lower the Pr valence state. The Zr amount stabilized in the distorted octahedral site is at the origin of the formation of defined compositions as discovered by Leroy Eyring et al. in the PrnO2n-2m series and the generation of oxygen vacancies stabilized in the fluorite-type network. TGA and TPR analyses help to follow the reduction properties under Ar/5% H2 and show high Pr reducible rates at low temperatures (T < 250 °C). The identification of the fluorite-type superstructure (SG: Ia3[combining macron]) of reduced compositions annealed at T = 900 °C under Ar/5% H2 shows the cationic and oxygen vacancy ordering. This feature plays a key role with Zr(4+) cations stabilized in flattened octahedral sites for the generation of oxygen vacancies and the stabilization of Pr(3+) in the reduced states.

Mannose-binding lectin exon 1 and promoter polymorphisms in tuberculosis disease in a Mediterranean area.

Mannose-binding lectin (MBL) is a serum protein that activates the complement and mediates phagocytosis. MBL levels and MBL2 genotype may impact upon host susceptibility to tuberculosis (TB) disease but evidence to date has been conflicting. MBL2 exon 1 and promoter genotyping and serum MBL concentrations were determined in 79 patients with active tuberculosis (58 pulmonary TB and 21 extrapulmonary or miliary TB) and 120 household healthy contacts (HHC) from a Mediterranean area (Majorca Island, Spain). Significantly higher serum MBL levels were found in patients with active tuberculosis than in HHC [median MBL concentrations 3430 ng mL(-1) (10-28 415) and 2600 ng mL(-1) (5-20 000) respectively, P = 0.002]. These higher MBL levels were mainly related to the most prevalent YA/YA wild-type diplotype. There was a strong correlation between MBL2 exon 1 and promoter genotype and MBL levels. The diplotype LYQA/HYPA was present in 12 out of 57 of the pulmonary TB cases but in none of the extrapulmonary TB patients. Diplotype LXPA/HYPA, producer of high levels of MBL, was significantly more frequent in HHC than in patients (16.8% vs. 6.4%, P = 0.031) suggesting a protective role against the development of TB disease that has not been previously found.

Anterior retroperitoneal rami: until now unnamed direct branches of the abdominal aorta.

The aim of the study was to gain a thorough knowledge of the topography and distribution of until now officially unnamed minute direct branches from abdominal aorta, stemming from its ventral and lateral aspects, supplying surrounding tissue, and to comprise it to the existing studies. The study was performed in fixed cadaverous material collected from India ink injections of abdominal aorta samples with large surrounding retroperitoneal tissue. The 25 samples were dissected under magnifying binocular glass, followed by graphic reconstruction; statistical analysis, and the study was preceded with detailed review of branches from abdominal aorta. For systematization of the segmental anatomy of the abdominal aorta and infrarenal segment of inferior vena cava, we defined three levels in this area. The retroperitoneal branches were most frequently situated simultaneously within all three predefined levels according to renal and inferior mesenteric arteries origin. There were 18% of retroperitoneal branches within Level 1, 39% within Level 2 and 43% within Level 3. They were branches not only from the abdominal aorta, but also from the testicular/ovarian artery, common iliac artery and in one case from the right accessory renal artery. Paired arrangement was recorded mainly cranially to the origin of inferior mesenteric artery, unpaired branches were more frequently found caudally. In conclusion, due to the terminological disunity of these arteries in the clinical literature and total absence in the anatomical literature, we propose to denominate them as anterior retroperitoneal branches of abdominal aorta (rami retroperitoneales anteriores aortae abdominalis).

Crossover external fixator for acetabular fractures: a cadaver study.

BACKGROUND: Dislocated acetabular fractures in polytraumatized patients are very challenging cases to deal with. Temporary stabilization by skeletal traction is difficult in these patients. A more effective solution can be an external fixation. OBJECTIVE: The authors designed a new crossover external fixation frame for acetabular fracture. The aim of this study is the biomechanical testing of this frame on human cadavers. METHODS: This study is an experiment on ten human cadavers. The acetabular fracture C2.2 was created. The stabilization effect of external fixation was compared with stabilization by large distractor. Femoral heads' shifts caused by standardized manipulation with the cadaver were obtained from X-ray pictures. RESULTS: The mean total shift in stabilization technique by external fixation was 2.56 (1-4) mm. In stabilization by large distractor, the mean of the total shift after cadaver manipulation was 5.11 (0-10) mm. No significant differences were found between stabilization by external fixation and by large distractor (p = 0.066). CONCLUSIONS: The stabilization of acetabular fracture C2.2 by a crossover external fixator is as effective as large distractor. The crossover external fixation could be a suitable solution for the temporary stabilization of acetabular fractures in polytraumatized patients. Subsequent studies including clinical trials are necessary to confirm the authors' suggestion.

Developmental malformations in the area of the lumbosacral transitional vertebrae and sacrum: differences in gender and left/right distribution.

PURPOSE: The aim of this study was to determine the incidence of congenital malformations of the lumbosacral transitional vertebrae in the general population, and the differences in their gender and left/right distributions. METHODS: The examined group comprised of all patients who underwent a pelvic X-ray during 2010 for any reason. The observed parameters included the following malformations: the presence of megatransversus at L5; sacralization of L5 or L6; a S1 lumbarization; the presence of six sacral vertebrae; or spina bifida at the level of L5, S1 or S2. In cases of megatransversus at L5, the lateral distribution was recorded. A total of 1,513 images were evaluated. Sex and lateral differences were evaluated using the Pearson's (χ (2)) test with a significance level of 5 %. RESULTS AND CONCLUSIONS: A total of 478 malformations were found in 417 patients, which constituted 27.6 % of the entire group. Malformations occurred in 250 women (25.4 % of all women) and 167 men (31.6 % of all men) and the female to male ratio in affected individuals was 1.5:1. The predominance of the occurrence of malformations observed in men was statistically significant (p = 0.009). The most frequently occurring malformations were the presence of six sacral vertebrae (179 patients) and megatransversus at L5 (150 patients). The study confirmed a high incidence of congenital malformations in the area of the lumbosacral transitional vertebrae and demonstrated a higher incidence in males. Unilaterally occurring megatransversus at L5 was significantly more common on the left side.

Mycobacterium avium-intracellulare pulmonary infection complicated by cutaneous leukocytoclastic vasculitis in a woman with anorexia nervosa.

A 53-year-old Caucasian woman with a history of anorexia nervosa developed a bilateral lower extremity rash comprised of palpable red to violaceous, sub-centimeter papular lesions that increased in quantity rapidly. She also noted a 2-month history of non-productive cough. Imaging modalities revealed a thin-walled cavitary lesion in the right lung apex and scattered nodular opacities. Acid fast bacilli (AFB) were found in sputum and subsequently identified by culture as Mycobacterium avium-intracellulare (MAI). Punch biopsies of her skin lesions yielded a histological diagnosis of small-to-medium vessel vasculitis. Stains and cultures for organisms were negative. Her skin lesions resolved quickly after the initiation of antimicrobial therapy for MAI. Hypersensitivity vasculitis associated with an atypical mycobacterial infection is unusual. The postulated underlying mechanism is the deposit of immune complexes and not the bacillus itself. While cutaneous leukocytoclastic vasculitis (CLV) due to MAI is certainly a rare entity, it should be entertained in patients with vasculitic skin lesions and a concomitant pulmonary disease.

[Intraoperative CT navigation in spinal and pelvic surgery: initial experience]. / Peroperacní CT navigace u operací pátere a pánve: první zkusenosti.

INTRODUCTION: The authors describe their first experience with virtually navigated pelvic and spine screws based on perioperative CT navigation. MATERIAL AND METHODS: From 22 October 2012 (launching the device) to 9 January 2013, a total of 15 CT-navigated pelvic and spine operations were performed in 14 patients. Nerve root compression, scoliosis, vertebral fracture and spondylodiscitis were the indications for spine procedures; B-type and C-type fractures according to the AO classification were the indications in pelvic surgical procedures. The preparation and the course of the procedures were in accordance with current standards and recommendations in all the cases. Perioperative navigation and subsequent examination of the screw trajectory were performed via O-arm imaging system (Medtronic Navigation, Louisville, Colorado) instead of the standard C-arm fluoroscopy. RESULTS: A total of 73 screws were inserted (60 transpedicular screws into cervical, thoracic and lumbar vertebrae, 9 iliosacral screws into the first sacral vertebra and 4 pubic screws). Only one of the pubic screws (1.4% of all screws) was found malpositioned at the subsequent perioperative examination and was extracted immediately and replaced. Further complications were not observed and none of the procedures had to be converted into a standard fluoroscopy guided operation. CONCLUSION: A short but intensive experience with perioperative CT navigation allows us to state: 1. CT navigation shortens the operating time and minimalizes the risk of screw malposition in multiple screw spine procedures; 2. CT navigation improves the introduction of iliosacral and pubic screws in pelvic fixations; 3. there is virtually no radiation load to the staff using the CT navigation; 4. mastering this technique will allow a wider use of miniinvasive screw insertion in the pelvis and other regions where minimal dislocation will enable miniinvasive internal fixation.