The advantages of combining sonotopogram with indication and fixation in invasive ultrasound.

The usefulness of sonotopogram, that is mapping of the operated area basing on ultrasound, is obvious and currently unquestionable. It is performed in order to improve safety level of a patient treated by means of invasive techniques. It constitutes an excellent complement of the Perioperative Control Card. At the beginning it was used in sonosurgical procedures, with time it has become an element of all surgical techniques. It undergoes multiple changes depending on the surgeon's needs. A particularly interesting phenomenon is the combination of the invasive techniques in order to facilitate the performance of medical procedures. Because of some relationship we are going to present the combination of sonotopogram with fixation and indication techniques. They are puncture techniques which are relatively rarely used in invasive ultrasound and surgical procedures. It seems that this results from the ignorance of their potential and the technique of their performance. Great simplicity makes them universal and allows to combine them freely. This simple combinations can be extended practically endlessly - similarly to domino bricks. For example, the next element of the technique combining can be the removal of an indicated and fixated element or a nailing. It is an excellent example of the complementarity rule - it should facilitate the understanding of Allin1 techniques and sonosurgery and also help in everyday practice of doctors performing invasive procedures. The use of these methods should be propagated not only in ultrasound but also in everyday medical practice in all the specialties. The presentation of the examples of particular techniques and their combination enables to bring closer their practical use.

Citric acid cough threshold in patients with gastroesophageal reflux disease rises after laparoscopic fundoplication.

BACKGROUND: It has been reported that antireflux surgery can diminish chronic cough due to gastroesophageal reflux disease (GERD) that is resistant to pharmacologic therapy. The aim of this study was the assessment of citric acid cough threshold (CACT) in patients with chronic cough due to GERD before and 3 months after laparoscopic Toupet fundoplication. METHODS: Thirty subjects (20 women and 10 men; median age, 45.3 years) with chronic cough due to GERD and 15 healthy volunteers underwent cough challenge with doubling concentrations of citric acid. Twenty subjects with GERD, a group of 14 women and 6 men (mean age, 45.5 years), underwent the same protocol 3 months after laparoscopic fundoplication. Daytime and nighttime cough score questionnaires (verbal category descriptive score) were completed in all groups. RESULTS: The geometric mean of CACT was significantly lower in GERD patients (9.62 mg/mL) than in healthy volunteers (50.8 mg/mL, p < 0.001). The results of cough score measurement significantly improved within 2 weeks after laparoscopic surgery. In 13 weeks of postoperative follow-up, cough disappeared or was greatly improved in 14 of the 20 patients (70%); in 3 other patients, cough resolved partially. In three patients. there was no improvement in cough. Cough challenge after surgery revealed a significant increase in mean cough threshold, from 8.28 to 19.03 mg/mL (p < 0.05). CONCLUSIONS: The results suggest that GERD influences CACT, which was significantly lower in GERD patients compared to healthy subjects. A significant correlation was found between subjective and objective measurements of cough in GERD patients. We found laparoscopic fundoplication to be objectively beneficial in GERD-induced chronic cough, as it reduced the CACT.

Stabilization of forearm fractures in children using intramedullary Kirschner wires.

Background. Minimally invasive intramedullary stabilization is a widely accepted method for treating long bone fractures in children. Indications concerning age and type of fracture have increased in the last decade. The aim of our study was to assess outcome in intramedullary Kirschner wire stabilization used to treat forearm fractures in children. Material and methods. From 1997 to 2004 intramedullary stabilisation was performed in 118 patients, 27 girls and 91 boys, ranging in age from 1 to 17 years (average 10.7 years). There were 191 fractured bones, 116 radius and 75 ulna. The procedure was done under general anesthesia. After manual reposition, the fracture was stabilized with an intramedullary Kirschner wire introduced under X-ray control. Results. There were no intraoperative complications. The mean duration of hospitalization in cases with isolated forearm fracture was 1.6 days. In 5 cases (4.2%) a minor soft tissue infection at the point of wire introduction was observed. There were no bone infections or damage to growth cartilage. In 112 operated children (94.9%), a good clinical outcome was achieved, while in 6 cases (5.1%) the outcome was satisfactory. Conclusions. Intramedullary Kirschner wire stabilization is a technically easy minimally invasive procedure. The method gives good clinical outcomes and decreases hospitalization, treatment costs, and stress connected with hospitalization. Intramedullary stabilization should be method of choice in the surgical treatment of forearm fractures in children.