Basic Differences and Most Common Findings in Ultrasound Examinations of Musculoskeletal System in Children: A Narrative Literature Review.

We present basic differences in the musculoskeletal ultrasound examinations between adults and children. Examiners who deal with adults on a daily basis have shared concerns about examining children. Such concerns may arise from the different approach to child ultrasounds, but they also come from differences in anatomical characteristics according to developmental age. We discuss the presence of growth plates, as well as non-mineralized parts of the bones. We also refer to the pathologies most often found in ultrasounds in early developmental stages. In the PubMed database, the set of keywords: "msk ultrasound in children", "pediatric msk sonoanatomy", "coxitis fugax", "pediatric Baker's cyst", "Baker's cyst ultrasonography", "bone septic necrosis in ultrasonography", "ultrasonography in juvenile idiopathic arthritis", and "ultrasonography in juvenile spondyloarthropathies", was used to identify a total of 1657 results, from which 54 was selected to be included in the article. We discuss the problem of osteochondritis dissecans, Osgood-Schlatter disease, examples of ligament injuries (especially in relation to the knee and ankle joints), exfoliation of growth cartilages, osteochondroma, exudates and inflammations affecting joints, and Baker's cysts. In this way, we have collected useful information about the most common diseases of the musculoskeletal system in children.

The COVID-19 pandemic as a factor of hospital staff compliance with the rules of hand hygiene: assessment of the usefulness of the "Clean Care is a Safer Care" program as a tool to enhance compliance with hand hygiene principles in hospitals.

INTRODUCTION: Hand cleansing and disinfection is the most efficient method for reducing the rates of hospital-acquired infections which are a serious medical and economic problem. Striving to ensure the maximum safety of the therapeutic process, we decided to promote hand hygiene by implementing the educational program titled "Clean Care is a Safer Care". The occurrence of the COVID-19 pandemic affected the compliance with procedures related to the sanitary regime, including the frequency and accuracy of hand decontamination by medical personnel. OBJECTIVE: The objective of the study was to assess the usefulness of the educational program titled "Clean Care is a Safer Care" as a tool for increasing compliance with hand hygiene principles. METHODS: We monitored the compliance with the hygiene procedure before implementation of the program as well as during the hand hygiene campaign by means of direct observation as well as the disinfectant consumption rates. RESULTS: In the initial self-assessment survey, the hospital had scored 270/500 points (54%). Preliminary audit revealed the hygiene compliance rate at the level of 49%. After broad-scaled educational efforts, the semi-annual audit revealed an increase in hand hygiene compliance rate up to 81% (hospital average) while the final audit carried out after one year of campaigning revealed a compliance rate of 77%. The final score for the hospital increased to 435/500 points. CONCLUSIONS: COVID-19 pandemic dramatically increased accuracy of proper hand hygiene procedures and consumption of disinfectant agents. The educational program has succeeded to reach its goal; however, long-term educational efforts are required to maintain and improve the quality of provided services.

Ultrasound-guided biodegradable subacromial spacer implantation in a patient with massive irreparable rotator cuff tears.

The aim of this manuscript is to present a modification of the current arthroscopic implantation technique of a biodegradable subacromial spacer. This modified ultrasound-guided technique was intended to maximally reduce the invasiveness of the procedure. The ultrasound technique was used to measure the subacromial space for an optimal fit and to verify subacromial spacer placement in the sagittal and frontal planes. This finding is of particular importance for patients with contraindications to general or regional anesthesia. The follow-up (5 months) of subacromial spacer implantation using ultrasound in a patient with an irreparable rotator cuff tear showed correct spacer placement.

Mesenchymal stem cells for the treatment of complex perianal fistulas in patients with Crohn disease.

Treatment of perianal fistulizing Crohn's disease is demanding and burdened with a high percentage of failures, which forces clinicians to search for new, more effective therapeutic options. One of these options is the use of adipose-derived mesenchymal stem cells in local administration. Due to their multipotentiality and complex mechanism of action, stem cells are the promising new therapeutic approach for the treatment-refractory complex perianal fistulas - demonstrating both high efficacy and a favorable safety profile. The paper presents current knowledge on the mechanisms of action and manner of administration of mesenchymal stem cells, as well as the effectiveness and safety of their use in the treatment of perianal Crohn's disease based on available literature.

Comparative analysis of five-year outcomes of lower extremity varicose vein therapy using monopolar and segmental radiofrequency ablation.

BACKGROUND: To compare efficacy and safety of segmental and monopolar radiofrequency ablation in the management of lower extremity varicose veins. METHODS: A total of 193 patients were treated with segmental RF ablation (Venefit; N.=97) or monopolar RF ablation (EVRF; N.=96) for lower extremity varicose veins from 2010 to 2012. A single extremity of each patient with isolated GSV or SSV insufficiency was enrolled. The differences between the two groups in demographic parameters, disease severity, treated veins, peri- and postoperative complications, and treatment efficacy indicators (VCSS) were evaluated. RESULTS: Based on Kaplan-Meier's analysis, the occlusion rate after 5 years was 87.6% in Venefit group and 87.8% in EVFR group (P>0.05). Varicose vein recurrence rates were 10.3% and 12.9% in the Venefit and EVFR groups, respectively (P>0.05). The VCSS reduction was comparable between the two groups (P<0.05). CONCLUSIONS: Venefit and EVRF systems can be considered equivalent in terms of efficacy and safety in the management of lower extremity varicose veins.

A review of ultrasonographic methods for the assessment of the anterior cruciate ligament in patients with knee instability - diagnostics using a posterior approach.

AIM: The purpose of the study was to improve the ultrasonographic assessment of the anterior cruciate ligament by an inclusion of a dynamic element. The proposed functional modification aims to restore normal posterior cruciate ligament tension, which is associated with a visible change in the ligament shape. This method reduces the risk of an error resulting from subjectively assessing the shape of the posterior cruciate ligament. It should be also emphasized that the method combined with other ultrasound anterior cruciate ligament assessment techniques helps increase diagnostic accuracy. METHODS: Ultrasonography is used as an adjunctive technique in the diagnosis of anterior cruciate ligament injury. The paper presents a sonographic technique for the assessment of suspected anterior cruciate ligament insufficiency supplemented by the use of a dynamic examination. This technique can be recommended as an additional procedure in routine ultrasound diagnostics of anterior cruciate ligament injuries. RESULTS: Supplementing routine ultrasonography with the dynamic assessment of posterior cruciate ligament shape changes in patients with suspected anterior cruciate ligament injury reduces the risk of subjective errors and increases diagnostic accuracy. This is important especially in cases of minor anterior knee instability and bilateral anterior knee instability. CONCLUSIONS: An assessment of changes in posterior cruciate ligament using a dynamic ultrasound examination effectively complements routine sonographic diagnostic techniques for anterior cruciate ligament insufficiency.

Multiple orifices are better than single in the endoscopic treatment of pancreatic pseudocysts.

BACKGROUND/AIMS: The aim of this study was to compare the surgical drainage of large, symptomatic pancreatic cysts (>5 cm) with single- and multi-channel endoscopic drainage. MATERIALS AND METHODS: In the period 2005-2010, we treated 112 patients with post-inflammatory pancreatic cysts. Thirty-six patients underwent surgical internal drainage. The remaining group of patients was treated endoscopically. In 28 of them, drainage was performed by anastomosing the cyst to the gastrointestinal tract using a single pig tail drain and then widening the channel to a diameter of 15 mm. Forty-eight patients underwent multi-channel cystic drainage. It consisted of connecting the cyst to the stomach and/or duodenum using at least 3 drains. Each connection was widened to a minimum diameter of 15 mm to ensure free drainage of the morphotic elements of the cyst. Each procedure was preceded by abdominal computed tomography to determine the exact location of the cyst in relation to the gastrointestinal tract and a Doppler ultrasound scan to determine the location of the blood vessels modeling on its surface. RESULTS: In 48 patients with multi-channel drainage, there was no obstruction of the anastomosis, and cysts closed within 4 months. The drains were removed after about 3 months. The created channels were patent for about 3-4 weeks, which was enough to completely close the cyst. CONCLUSION: Multi-channel endoscopic anastomosis of pancreatic cyst to the gastrointestinal tract is a very effective method for drainage of large post-inflammatory pancreatic cysts, comparable in terms of effectiveness with the surgical method but less invasive.

[Effectiveness of treatment of varicose veins assessed by epidemiological comparative studies]. / Efektywnosc leczenia zylaków w swietle porównawczych badan epidemiologicznych.

Effectiveness of varicose veins (VV) management, due to high prevalence of this condition, is an important medical, social and economical issue. The aim of the study was to compare cost effectiveness of VV treatment by comparison of the results of two epidemiological surveys performed in Warsaw Bródno population, in 1982-1984 (group I, n=4997) and 1998-2000 (group 11, n=3556). Analysis compared prevalence of varicose veins, venous ulcers, deep vein thrombosis (DVT) in relation to number of VV procedures performed, and cost of conservative and surgical treatment, subjective patients' assessment of treatment results. Varicose veins prevalence has not changed significantly in group I was 15.7% (men 9.3%, women 20.1%) vs. 13.7% (men 8.7%, women 15.9%) in group II. Similarly, prevalence of venous ulcers (0.76% vs 0.73%), and previous DVT among VV patients (8.9% vs 8.9%) have not changed in both groups. Percentage of patients treated surgically in relation to all VV patients (19.7% vs 26.1%), as well as treated conservatively (45.2% vs 48.8%) increased, the latter mainly due to significant increase of ratio of patients treated with phlebotropic drugs. Patients'assessment of conservative and surgical treatment has improved dramatically, cost of treatment remained similar. Despite significant surgical and conservative treatment efforts, prevalence of essential venous diseases in hospital catchment area remained unchanged. Amount of patients satisfied both with surgical and conservative treatment increased, perhaps mainly due to better efficacy of phlebotropic drugs and better access to specialist care. On the other hand, significant amount of patients doesn't start any treatment at all. We conclude that preventive varicose veins surgery during early stage of disease may not diminish prevalence of serious venous complications.

[New possibilities in treatment of atherosclerosis--increase of nitric oxide synthesis by L-arginine supplementation]. / Nowe mozliwosci leczenia miazdzycy--zwiekszenie syntezy tlenku azotu poprzez suplementacje L-argininy.

Diseases such as heart attack, stroke or critical atherosclerotic leg ischaemia are very common in the developed countries. It is estimated that they are the main cause of deaths in the age group over 40 years. Patients with advanced leg ischaemia can be treated surgically. However in distal disseminated occlusions, surgery is technically impossible. In such cases amputation is the treatment of choice, but postoperative death ratio in this group is still high. That is why new ways of atherosclerosis treatment are needed. Progress in vascular biology brings new methods of treatment. Discovering of vasodilatory effect of nitric oxide makes us seek for ways of increasing its endogenous synthesis in endothelium of blood vessels. Studies on angiogenic cytokine application, amplification of NO synthesis expression and other gene engineering techniques are carried out in order to increase the concentration of nitric oxide in endothelium. It has been found that an increase of nitrix oxide synthesis can be achieved by administering L-arginine. Numerous trials suggest that supplementation of this amino acid can be of great therapeutic importance in patients with various atherosclerotic diseases. Clinical effectiveness of L-arginine is comparable to conventional pharmacotherapy. It seems that in the near future L-arginine supplementation may contribute to better results of atherosclerosis treatment.