[Paget's disease of bone--treatment with alendronate, calcium and calcitriol]. / Pagetova kostná choroba--liecba alendronátom, kalciom a calcitriolom.

In the submitted case-history the authors describe the clinical picture, diagnosis and treatment of the non-complicated form of Paget's disease in a 68-year-old patient with typical X-ray findings on the vertebrae, pelvis and left tibia. The laboratory findings revealed liminal alkaline phosphatase (ALP) values, 2.5 times raised values of the aminoterminal telopeptide of collagen I in the organic bone matrix (NTx) in the 24-hour diuresis and slightly elevated osteocalcin (OSCA) levels. The finding of whole-body skeletal scintigraphy was atypical and thus was no diagnostic asset. Aimed transiliacal bone biopsy according to Bordier taken from the pathological focus confirmed the diagnosis of morbus Paget. The patient was treated for six months with the following preparations: Fosamax (monosodium alendronate tablets a 10 mg, Merck Sharp and Dohme, USA) 1 tablet per day, Vitacalcin (calcium carbonate, tablets a 250 mg elemental calcium, Slovakofarma, Slovak Republic) 2 x 1 tablet per day, Rocaltrol (calcitriol tablets a 0.25 ug, Hoffman La Roche, Switzerland) 1 tablet on alternate days). Because of gastrointestinal complaints the authors did not administer 40 mg alendronate per day, as recommended in the American literature. Based on the laboratory finding of normalization of the bone turnover, reduction of the number of osteoplastic foci on the X-ray image of vertebrae and pelvis, regression of the vertebrogenic algic syndrome and improved mobility of the patient, the authors consider the 6-month administration of alendronate, 10 mg per day, calcium carbonate and calcitriol therapeutically effective and successful.

[Primary intraosseous liposarcoma - case report.]. / Primárny kostný liposarkóm - kazuistika.

Primary intraosseous liposarcoma belongs to exceptional tumors rarely found on the sceleton. There are only several tens of cases described in literature and they are published as case reports. Because there is not enough experience, especially with diagnostics of this illness, it happens that it is considered as malignant fibrous histiocytoma, malignant mesenchymoma or with secondary infiltration of liposarcoma of soft tissue into the bone. Authors tried (in correlation with the clinical outcome studies of macroscopic samples with detailed histologic examination) to overcome diagnostic uncertainities of this case. Key words: primary intraosseous liposarcoma, maligant bone tumors.

[Our Strategy of the Treatment of Giant-cell Tumours Part I - Strategy.]. / Nasa metodika liecby obrovskobunkových kostných nádorov I. cast: metodika.

The authors present a treatment procedure in giant-cell tumours of limbs applied in the recent three years at Ist Orthopaedic Clinic in Bratislava. The procedure begins with cytologic verification (in most cases within one stage procedure by peroperative cytologic examination) followed by careful curretage of the lesion, irrigation by liquid non-diluted solution of phenol, irrigation with pure 96% ethylalcohol, irrigation with physiological solution, filling with bone cement. In the methodological part of the contribution the authors discuss toxicity of phenol and risks of this treatment which they confront with the existing data in the literature. Key words: giant-cell tumours, chemoproteolysis, phenol, bone cement.

[Morphological analysis of synovial exsudate in rheumatoid arthritis. II. Transmission electron microscopy]. / Morfologická analýza synoviálneho výpotku pri reumatoidnej artritíde. II. Transmisná elektrónová mikroskopia.

Synovial exsudate cells from patients with rheumatoid arthritis were investigated by transmission electron microscopy. Most of them represented polymorphous leukocytes. They contained vacuoles full of material reminding of immune complexes (in addition to typical granules) and plentiful alpha and beta glycogen granules. Some lymphoid cells nuclei were alike to those of Sézary disease with frequent ring-shaped nucleoli and enlarged mitochondria. Variegated non-lymphoid mononuclear cells had lateralized nuclei with marginated chromatin, mitochondria with sparse crists, short membranes of reticulum, conspicuous cisterns in trans-Golgi area and lysosomes with myeline bodies as a sign of big capacity of phagocytosis. Importance of using transmission electron microscopy in analysis of synovial exudate was discussed.

[Morphologic analysis of synovial effusion in rheumatoid arthritis. I. Light microscopy--cytology, histochemistry and semi-thin sections]. / Morfologická analýza synoviálneho výpotku pri reumatoidnej artritíde. I. Svetelná mikroskopia--cytológia, histochémia a polotenké rezy.

Inflammatory synovial fluid in patients with rheumatoid arthritis contained IgG, IgM and C3 component of complement, unspecific esterase and acid phosphatase and affinity to Pisum sativum agglutinin (PSA). Various forms of a degeneration of polymorphs, giant non-lymphoid mononuclear cells with cerebriphorm nuclei in different stages of phagocytosis and lymphocytes, sometimes with numerous nuclear invaginations, were found. All the cells of synovial fluid contained IgG, not the IgM. C3 component of complement was limited to non-lymphoid non-lymphoid mononuclear cells. Both the enzymatic activities were especially stressed in polymorphs. PSA was bound to all cells.

[Reconstruction of acetabular insufficiency in initial total hip endoprosthesis surgery using a massive autograft (fate of the implanted autograft more than one year after surgery)]. / Rekonstrukcia insuficientnych acetábul pri prvotných totálnych endoprotézach koxy masívnymi autostepmi (Osud implantovaných autostepov viac ako rok od operácie).

The authors present a method of reconstruction of insufficient acetabula by autografts from heads of femurs before primary implantation of the cemented total endoprosthesis of the coxa. They reconstruct the osseous acetabulum of the patient by prolonging it, filling or reinforcing its floor, although in one third of the patients it is difficult to find a borderline between these three groups. Coxarthroses are primary and secondary and of those almost half are secondary dysplastic coxarthroses. The group of patients comprises 32 women and 17 men, their mean age at the time of operation was 58.5 years. The authors follow-up, using clinical and X-ray methods, the fate of "massive autografts". Within six months the autograft is already firmly linked with bone and within 12 months it is reconstructed. A bone graft, unless burdened, is gradually reabsorbed. This process is intensive in particular between the 3rd and 6th month after operation and by the 12th month the graft is reabsorbed.

[Infected fractures of the leg treated by splints.]. / Infikované zlomeniny predkolenia liecené dlahovaním.

The authors present their method of treatment of suppurative pseudoarthroses which involves three stages: 1. excision, 2. fixation (stabilization), 3. reconstruction. Their method was inspired by the two-stage technique elaborated by Papineau. The first two stages of treatment are made during one surgical session and involve the removal of all alien and necrotic tissue and tissue altered by inflammation. For fixation of bone segments the authors use an external frame of their own design. Reconstruction is performed by means of spongiose autografts on the 15th day after the first surgical session using the method "support of the revitalized adjacent fibula" with partial, cca 80%, closure of surrounding soft tissues and skin. The method is demonstrated in a group of 18 infected fractures of the leg treated primarily by surgery, using splints. Key words: osteosynthesis of the leg by splints, infected pseudoarthrosis of the leg, autospongioplasty.