Barrier behaviour of partially N-acetylated chitosan layers in aqueous media.

Chitosan coatings of 353 ± 12 nm thickness were prepared on glass and zinc substrates by dip-coating method to study their barrier-behaviour. The coatings were chemically modified to increase their degree of acetylation (DA) from ca. 44 % up to ca. 98 % resulting a quasi-chitin coating. The effect of the acetylation reaction was studied by infrared spectroscopy, and the structural changes of the native and acetylated coatings were investigated by UV-Vis spectrophotometry and X-ray diffraction. The surface properties of the coated samples were characterized by wettability measurements - advancing water contact angle decreased from ca. 80° (native) to ca. 43° (fully acetylated) - and microscopic (SEM, AFM) studies. The barrier behaviour of the chitosan layer depending on the DA was evaluated by electrochemical impedance spectroscopy studies and with a special mesoporous silica - chitosan bilayer system by measuring the amount of dye (Rhodamine 6G) accumulated in the silica through the chitosan coating during an impregnation step. These methods showed significant decrease in the barrier-effect of the coatings with increasing DA (accumulation of approximately six times more dye and a reduction of charge transfer resistance by an order of magnitude), due to the structural and ionization changes in the coatings.

Finite-element-based 3D computer modeling for personalized treatment planning in clubfoot deformity: Case report with technique description.

RATIONALE: In clubfoot deformity, planning of corrective treatment requires a complex understanding of the foot anatomy, as well as of the geometry and distribution of altered mechanical forces acting at the level of the deformed foot. At the same time, treatment success depends largely on the selection of the most appropriate shape and angles of the customized orthesis developed for foot correction. Therefore, a complex assessment of the intensity and distribution of the mechanical forces at this site is mandatory prior to initiation of any corrective therapy. PATIENT CONCERNS: We present here the case of a 3-year-old male child with clubfoot deformity, weighting 20 kg, with no other congenital malformations, in whom finite element modeling (FEM) technology associated with a newly developed technique of three-dimensional (3D) computational simulation was applied for personalized treatment planning. INTERVENTIONS: The FEM-based computational 3D simulation technique allowed selection of the corrective treatment associated with the most physiologic pattern of force distribution at the level of the foot. OUTCOMES: The proposed technique led to selection of the most appropriate therapy that successfully corrected the foot deformity. After 3D computer simulations, the elongations recorded were 2.71 cm for Achilles tendon, 1.69 cm for anterior tibialis tendon, 1.35 cm for the long flexor of the toes, and 1.69 cm for the long flexor of the hallux. The Von Mises equivalent stress distribution was σ = 4.26 MPa, not exceeding the elastic capacity of the bones, therefore the residual deformations were minimal. The customized treatment selected in this way was highly appropriate for the child, and led to complete recovery of the deformity in three months. LESSONS: This case is the first one in which FEM-based computational 3D modeling was applied for selection of treatment strategy in a child with clubfoot. The case reported here illustrates the role of advanced medical computer technology, based on complex image processing, FEM and 3D simulations, in providing an effective clinical decision support tool for personalized treatment selection in children with clubfoot deformity.

[Traumatic asphyxia with permanent visual loss. Case report]. / Traumás asphyxia maradandó látásvesztéssel.

Traumatic asphyxia is a rare condition that occurs after compressive thoracoabdominal trauma, which is characterized by subconjunctival hemorrhage, cervicofacial cyanosis, edema and petechiae. Serious life-threatening thoracic and abdominal injuries may coexist. After conservatory treatment in most cases complete recovery is achieved, but in isolated cases permanent neurological lesions may occur. We present the case of the 39-year-old male patient who suffered a compressive thoracoabdominal trauma. The physical examination showed the characteristic "ecchymotic mask". After surgical treatment of the abdominal injuries and intensive therapy the patient was discharged with permanent vision loss. The high retrograde venous pressure in the head and neck may be associated with neuronal ischemia, which can lead to irreversible optic nerve atrophy. It is therefore important to carry out an early, routine and complete ophtalmologic examination, especially in the intubated and poorly cooperative patients. Orv Hetil. 2017; 158(22): 864-868.

[Van Neck-Odelberg disease. Report of two cases]. / A van Neck-Odelberg-betegség bemutatása két eset kapcsán.

Osteochondritis ischiopubica or van Neck-Odelberg disease is characterized by atypical ossification of the ischiopubic synchondrosis. Clinical symptoms are usually pain, limping and limited range of motion of the hip joint. Radiologic images may be confused with the possibility of fracture, tumor or inflammation. In some cases it may be difficult to set up the accurate diagnosis, and during the diagnostic process it is essential that van Neck-Odelberg disease should be considered. In this paper the authors draw attention to this rare disorder and they present the history of two patients who posed diagnostic difficulties.

S53P4 bioactive glass and fibrin glue for the treatment of osteochondral lesions of the knee - a preliminary in vivo study in rabbits.

The role of the subchondral bone and the importance of treating both bone and cartilage in cases of chondral and osteochondral lesions of the knee have been highly emphasized. There are no current studies on the experimental use of bioactive glass S53P4 (BonAlive®) as granules in the treatment of osteochondral lesions of the knee. Our preliminary study was designed to establish an experimental model and assesses the effect of glass granules fixed with fibrin compared to fibrin alone as fillers of the osteochondral defects created in the weight-bearing and partial weight-bearing regions of the distal femur in six adult rabbits. We found that the size of the distal femur in adult domestic rabbits allows the creation of 4 mm diameter and 5 mm deep osteochondral defects on both the medial femoral condyle and the trochlea, bilaterally, without significantly affecting the activity level of the animals. Retention of the glass granules in the defects was achieved successfully using a commercially available fibrin sealant. At five weeks post-implantation, we found macroscopic and microscopic differences between the four types of defects. The use of bioactive glass S53P4 for filling condylar osteochondral defects in rabbit femora led to the initiation of an early bone repair process, observed at five weeks after implantation, while the filling of trochlear defects with fibrin glue resulted in the appearance of cartilaginous tissue characteristic of endochondral ossification.

Kite versus Ponseti Method in the Treatment of 235 Feet With Idiopathic Clubfoot: Results of a Single Romanian Medical Center.

Congenital idiopathic clubfoot (CC) represents the fifth common most congenital malformation which may be treated conservatively or by surgery. In this article, we present the results obtained in our clinic after conservative therapy performed with 2 methods.A total of 235 consecutive feet (161 patients) were conservatively treated using Kite (n = 129) and Ponseti method (n = 106). The Dimeglio score was determined before and at 6 months after treatment to compare the 2 methods. All of the patients were treated in their first week of life.CC was more frequently diagnosed in males (n = 93; 57.76%), bilaterality being seen in 45.96% of the patients (n = 74). Although before therapy the Dimeglio score was similar in both groups (P = 0.85), it was significantly improved in patients treated by Ponseti method (P = 0.005). Duration of therapy was also longer in patients from Kite versus Ponseti group (20 vs 11 weeks). Failure of orthopedic treatment was more frequent in Kite group (30.32% vs 8.49% of the patients) and the relapses rate at 6 months was also higher (35.65% vs 11.32%).The conservative method used to treat the CC should be adapted on the patient's age and Ponseti method seems to be the most effective type of treatment used for patients treated in their first week of life. Dimeglio score can be successfully used for evaluation of these children. This is the eighth published study that compare the efficacy of Kite versus Ponseti method.

Arteriovenous synovial hemangioma of the popliteal fossa diagnosed in an adolescent with history of unilateral congenital clubfoot: case report and a single-institution retrospective review.

Synovial hemangioma (SH) is a very rare soft tissue tumor; in our department, SH represented 0.07% from all soft tissue tumors (one case from 1311 soft tissue tumors), and 0.78% from all excised hemangiomas (one case from 128 hemangiomas) diagnosed over a five-year period. The aim of this paper was to present the clinicopathologic characteristics of hemangiomas and particularities of one SH of the popliteal fossa diagnosed in an athletic adolescent with previously corrected congenital clubfoot. To our knowledge, this is the 275 case of reported SH. A 13-year-old trick cyclist presented with two-year history of slowly growing mass of the left posterior fossa. The magnetic resonance imaging of the left knee showed a juxta-articular mass with intramuscular component. Open excision of the tumor and partial removal of the synovial membrane was the therapy of choice. Histopathological examination revealed clusters of large arteries and veins embedded in a fibrotic tissue, the tumor mass being lined by synovial membrane. Intramuscular growing was also confirmed. Without any other postoperative therapies, no recurrence or functional disorders were noted after 21 months of follow-up. SH of the knee should be excised as soon as possible to avoid complications such as muscle invasion and risk of recurrence.

Congenital clubfoot in children after walking age: management and evaluation of 41 feet with the dimeglio score.

INTRODUCTION: Congenital Clubfoot (CC) is one of the most frequent orthopedic lesions in patients younger than 10-15 years. The surgical correction is more difficult in children over 1.5 years, compared to newborns, due to advanced osteoarticular development and higher rigidity of the foot. The aim of this study was to report the results of our experience regarding the combined orthopedic-surgical treatment of CC and the follow-up prognostic value of Dimeglio score in children aged between 1.5 to 12 years. MATERIAL AND METHODS: From June 2009 and May 2012, 31 consecutive patients with CC, aged between 1.5 to 12 years, underwent surgical treatment. To assess the results, pre-operative and post-operative Dimeglio scores, at 6 months after surgery, were compared in each of the cases. An adapted Ponseti-Mitchelle orthosis-bar was used for aftercare. RESULTS: The mean age of patients enrolled in this study was 4.32±2.04 years old. From the 31 patients, 10 had bilateral deformity; surgical intervention was performed for a total of 41 feet. Independently by the age of patients, between pre-operative and post-operative evaluation, the Dimeglio score regressed from a mean of 11.70±7.43 (ranged between 4 and 18) to 3.80±0.96 (ranged between 0 and 12). Unfavorable outcome was observed in 5 feet; the success correction rate was 85.37%. CONCLUSION: This study reveals that CC can also be treated in older children by using a proper orthopedic, surgical and post-operative management. The Dimeglio score is useful, easy to use and relevant also in children over 1.5 years.