Reamed locked intramedullary nailing for studying femur fracture and its complications.

Morbidity associated with femur fractures in polytrauma patients is known to be high. The many unsolved clinical questions include the immunological effect of the fracture and its fixation, timing of fracture fixation, management of fracture non-union, effect of infection and critical size of bone defects. The aim of this study was to establish a clinically-relevant and reproducible animal model with regards to histological, biomechanical and radiological changes during bone healing. A custom-designed intramedullary nail with interlocking system (RabbitNail, RISystem AG, Davos Platz, Switzerland) was used for fixation, following femur fracture. New Zealand White rabbits were assigned to two groups: 1. closed fracture model (CF; non-survival model: n = 6, survival model: n = 3) with unilateral mid-shaft femur fracture created by blunt force; 2. osteotomy model (OT; survival model: n = 14) with unilateral transverse osteotomy creating femur fracture. There were no intraoperative complications and full-weight bearing was achieved in all survival rabbits. Significant periosteal reaction and callus formation were confirmed from 2 weeks postoperatively, with a significant volume formation (739.59 ± 62.14 mm3) at 8 weeks confirmed by micro-computed tomography (µ-CT). 2 months after fixation, there was no difference between the osteotomised and contralateral control femora in respect to the maximum torque (3.47 ± 0.35 N m vs. 3.26 ± 0.37 N m) and total energy (21.11 ± 3.09 N m × degree vs. 20.89 ± 2.63 N m × degree) required to break the femur. The data confirmed that a standardised internal fixation technique with an intramedullary nail for closed fracture or osteotomy produced satisfactory bone healing. It was concluded that important clinically-relevant studies can be conducted using this rabbit model.

[Ischemic colitis following AAA procedures]. / Ischemická kolitída po operáciách pre AAA.

INTRODUCTION: Bowel ischemia following the AAA operation is a rare complication. However, it is the most common reason of death after elective AAA operation with the incidence of 5-9% and 30-60% following RAAA operation with mortality rate around 60%. METHODS: Retrospective analysis of 207 patients undergoing elective and emergent AAA operation between 1st January 2007 and 31st July 2010 was made. We evaluated clinical and para clinical symptoms leading to the observed diagnosis. RESULTS: During the observed period we have treated 207 patients with the AAA. 174 (84%) patients were elective, 33 (16%) were urgent (RAAA). Postoperative mortality of the entire group was 19 patients (9.2%). The most common reason of death was found to be ischemic colitis--8 patients (42%). Ischemic colitis was diagnosed in 17 patients (8.2%) with the mortality 41.2%. Diagnosis was made by colonoscopy in 58.8% of patients, the rest was operated on following the clinical finding of an acute abdomen. In a group of patients with an early diagnosis and treatment of ischemic colitis (until the 4th post operative day) the mortality rate was 20%, increasing till 71.4% when the diagnosis was done later than on 4th postoperative day. DISCUSSION: Nevertheless the ischemic colitis is a rare complication following AAA operation the surgeon must be proactive regarding this severe complication especially in high risk patients. Clinical symptoms are not specific, most often too early peristaltic and diarrhoea with addition of blood is apparent. Procalcitonine and D-lactate seem to be promising among the blood markers. Colonoscopy is a method of choice if there is any doubt in postoperative process. The need of relaparotomy is given by colonoscopy finding together with clinical, biochemical symptoms, signs and the clinical status of the patient. The resection of diseased part of bowel with the colostomy is mandatory. CONCLUSION: The final diagnosis of ischemic colitis is difficult and the decision for reoperation is a matter of surgeons' experience despite of clinical and paraclinical findings. Only fast and adequate treatment can be successful. Any delay in diagnosis is fatal for the patients.

Detection of antibodies to Chlamydophila pneumoniae by immunoblotting in patients with cardiovascular diseases.

Chlamydophila pneumoniae, one of the most prevalent human pathogens worldwide, is not only a significant cause of pneumonia, but may also be associated with cardiovascular diseases (CVD) as suggested by multiple studies. A total of 228 sera from CVD patients with hypertension, ischemic heart disease or previous reconstructive vascular surgery were screened for the presence of anti-C. pneumoniae IgG and IgA antibodies by ELISA. Out of 150 positive serum samples, 80 with similar IgG and IgA levels were investigated by immunoblot (IB). IgG antibodies were directed predominantly against the 35 kDa and 39 kDa proteins as well as 50-54 and 56-60 kDa proteins of C. pneumoniae. IgA antibodies reacted most frequently with the 50-54 and 56-60 kDa proteins.

Comparison of accuracy of intramuscular fat prediction in live pigs using five different ultrasound intensity levels.

The objective of this study was to evaluate the possibility of prediction of intramuscular fat (IMF) in live pigs using ultrasound method. Moreover, the accuracy of prediction at five different ultrasound intensity levels was investigated. Cross-sectional images of longissimus dorsi muscle (LD) at right last rib area, from hybrid pigs, were taken. Each pig was scanned at the same frequency (3.5 MHz) and at the five different ultrasound intensity levels 70%, 75%, 80%, 85% and 90% of total amplifying of sonograph, using the device ALOKA SSD-500. The video image analysis was used to predict IMF content (ultrasound intramuscular fat (UIMF) 70 to UIMF90). The second day after slaughter, the dissection of right half carcass was done. A sample of LD at the last rib was taken for laboratory analysis of IMF content (LAIMF). Scatter plots with UIMF on the x-axis and LAIMF on the y-axis were constructed to account for individual variability within and between intensity levels. Correlations between LAIMF and UIMF were significantly different from zero (r = 0.40-0.52), except for correlation between LAIMF and UIMF90 (r = 0.14). Statistical model with LAIMF (the dependent variable), UIMF (the same model for each intensity level), live weight (the covariates) and sex (the fixed effect) was developed. Coefficients of determination (R2) were 0.33, 0.38, 0.34, 0.25 and 0.17 with UIMF at the intensity level 70%, 75%, 80%, 85% and 90%. Root mean square errors ranged from 0.516% to 0.639%. Standard errors of individual prediction ranged from 0.523% to 0.649%. Goodness-of-fit of the model was also justified by testing the residuals for normality. Although the results are not quite unequivocal in favour of the one intensity level, it seems that intensity levels 75% and 80% are the most suitable to predict IMF in live pigs. Further research is needed, mainly to increase accuracy of collecting, processing and evaluating the sonograms using video image analysis.

[Peripheral arterial disease of extremities--guidelines for diagnostic and treatment]. / Odporúcania pre diagnostiku a liecbu periférneho artériového ochorenia koncatín (PAO).

Diagnostic and therapeutic guidelines of peripheral arterial disease of extremities recommanded by five scientific societies of Slovak Medical Association (Slovak Angiological Society, Slovak Society for Vascular Surgery, Slovak Cardiologic Society, Slovak Internal Society and Slovak Radiologic Society) are discussed in this article. Peripheral arterial disease (PAO) of extremities is an important manifestation of systemic atherosclerosis The lower the ankle-brachial pressure index, the greater the risk of serious cardiovascular events (e.g. myocardial infarction, stroke). Nevertheless, patients with PAO are undertreated with regard to use of antiplatelet drugs or lipid-lowering drugs, as compared with patients with coronary artery disease.

[Clinical significance of venoplasties in infragenicular prosthetic bypass grafts]. / Klinický význam zilovej plastiky distálnej anastomózy pri infragenikulárnych protetických bypassoch.

AIMS: Analysis of medium-term patency of prosthetic infragenicular bypass grafts with venoplasty of distal anastomosis and evaluation of venoplasties in patients with critical limb ischemia. STUDY DESIGN: A single centre, retrospective, non-randomised study. METHODS AND RESULTS: In 1998-2005, 42 patients with critical limb ischemias were surgically managed at our clinic using infragenicular prosthetic bypass graft implantation with distal anastomosis venoplasty. 3 types of plasty were employed: Linton's, St. Mary's boot and Taylor's plasty. Mean follow-up period was 25 months and primary functionality was 69%. Long-term functionality (over 5 years) was 35% and limb salvage rate was 38%. Functionality was assessed using life table analysis. 19% of patients exited during the follow-up period. In up to 30% patients, thrombolytic therapy was indicated for late bypass occlusion with a success rate of 63%. CONCLUSION: Prosthetic crural bypass is a relevant alternative to proximal level limb amputation. Venoplasty of distal anastomosis increases volume of the anastomosis and compensates for incongruencies of the graft and recipient vein lumen. Based on our experience, not a type of venoplasty, but a fact of increasing the anastomosis volume is most important. Whenever crural reconstructions are indicated, patient's quality of life, expected survival period, degree of patient's independence prior to surgery and patient's compliance must be considered.

[Arthroscopy of the ankle joint--A rare cause of a pseudoaneurysm of the dorsalis pedis artery--A case review]. / Artroskopia clenkového klbu--zriedkavá prícina pseudoaneuryzmy pedalnej artérie--case report.

The arthroscopy is an attractive method for the diagnosing and treatment of injured joint structures in contemporary sport medicine. Vascular complications of this technique are very rare but generally extremely dangerous for the extremity salvage. We describe a rare case of the pedal artery pseudo aneurysm after ankle arthroscopy and the treatment of this complication.

[Cystic degeneration of the adventitia of the popliteal artery--case report]. / Cystická degenerácia adventície a. poplitea--case report.

Cystic adventitial disease (CAD) is a rare diagnosis with a higher number of the patients in recent years. The article gives a brief of the pathology and etiolopathogenesis of adventitial cystic disease and two case reports of the patients with CAD of the popliteal artery treated in our department between 1997 and 2001. Successful results are achieved only with surgical treatment.

[Regional biochemical and hematologic changes in patients after revascularization of the lower extremities in ischemia of the extremities]. / Regionálne biochemické a hematologické zmeny u pacientov po revaskularizácii dolných koncatín pre koncatinovú ischémiu.

INTRODUCTION: Surgical treatment of PAOD is related to iatrogenic ischaemia caused by arterial clamping and ischaemia which is result of natural development of the disease. The pathway of skeletal muscle reperfusion injury is complex and one of the most important factors related to injury is endothelial damage. The expected reason of endothelial damage is increased production of oxygen free radicals by prematurely activated PMN (polymorphonuclear) leukocytes (direct injury). Non-specific tissue injury is related to releasing of PMN elastase. Endothelial dysfunction, hypercoagulable state and microcirculation stasis are responsible for indirect injury and no-reflow fenomena. STUDY DESIGN: Observational pilot study. METHODS: 10 patients underwent surgery because of PAOD (all suffering from critical limb ischaemia). During reperfusion period in defined intervals following parameters were measured (samples were taken from ipsilateral femoral vein): PMN elastase, lactate, total antioxidant status, malondialdehyd, minerals, acid-base balance, blood count, APTT, prothrombin time, fibrinogen and HTI (heparin tolerance index). RESULTS: Patients with PAOD are threatened by hypercoagulable state with its clinical and surgical consequences. Maximal grade of local acidosis is reached 2 hours from the beginning of reperfusion. Tissue damage is expressed by maximum activity of PMN elastase 18-24 hours during reperfusion and represents non-specific tissue damage. Low total antioxidant status reveals high sensibility to oxygen free radicals. MDA does not achieve the pathological range in observed series. CONCLUSION: Our results confirmed inevitable importance of prevention of hypercoagulability, oxygen free radical tissue damage and PMN elastase activation to avoid of non-specific tissue damage.

[The popliteal artery entrapment syndrome--personal experience]. / Entrapment syndróm popliteálnej artérie--nase skúsenosti.

OBJECTIVE: In a retrospective study we analyze 5 patients with popliteal artery entrapment syndrome who were treated since 1999 to 2000 in our department. METHODS AND RESULTS: 5 patients were found to have popliteal vascular entrapment during a two-year period. From the total number of 5 patients, we performed surgery in 3 patients (5 operations). One patient rejected proposed surgical therapy, in another case the morphological lesion of the popliteal artery was not suitable for revascularisation. 3 patients underwent interposition of the diseased popliteal artery using a venous graft from a dorsal approach. Twice the decompression (myotomy) of the medial head of gastrocnemius muscle was sufficient. The study group is included in our follow up programme (median follow up 12.8 months, range from 3 to 24 months), primary and long term patency has been 100%. RESULTS: On the basis of our experience, we advice total replacement of the diseased popliteal artery. A dorsal approach (Hamming's "S" shaped incision) with interposition of the popliteal artery with autogenous venous graft, end to end anastomosis on both sides, seems to be the optimal solution. In case, the arterial wall is not irreversibly changed, surgical decompression (myotomy) is sufficient to prevent the development of symptomatic disease, also using the dorsal approach.

[Surgical treatment of abdominal aortic aneurysms in severe ischemic coronary disease]. / Operacná liecba aneuryziem abdominálnej aorty pri závaznej ischemickej chorobe srdca.

BACKGROUND: The abdominal aortic aneurysm (AAA) is one of the most serious problems of vascular surgery and general medicine, as well. Endovascular methods of treatment have been developing very rapidly, however, the conventional treatment of the AAA still predominates. The results of operative treatment have been influenced besides the delayed diagnostics of the AAA resulting in a high rate of ruptured AAA by the high comorbidity of the AAA patients population. The accentuation of the proper preoperative and perioperative management of patients could therefore significantly influence the results of the surgery. MAIN PURPOSE AND STARTING POINTS: Striking difference between the mortality of elective and emergent surgery of AAA has been unchanged despite the intensive effort of many centers. One of the main factors of mortality is the concomitant serious coronary heart disease (CHD), predominantly the acute myocardial infarction (MI). The paper analyses the possibilities to improve the results of AAA surgery by means of the patients selection and effective preparation before the elective surgery. The risk factors and concomitant diseases of patients suffering from the AAA, the elective and emergent surgery ratio and the operative mortality are referred. The results of surgical treatment before and after accepting the modern CHD management algorithm are compared. METHODS: The present study is a retrospective analysis of the data of 343 consecutive patients with AAA operated on during the 20-years period from 1 January 1979 to 31 December 1998. The 1st group of 249 patients operated on during the 18-years period from 1. January 1979 to 31 December 1996 was not subjected to special attention concerning the CHD and was compared with the 2nd group of 93 patients operated on from 1 January 1997 to 31 December 1998. In this group of patients special attention was focused on the improvement of surgical techniques, intensive care and comprehensive diagnostics, evaluation and proper management of the concomitant CHD. RESULTS: The mortality rate of the elective surgery in the 1st group was 5.5%, in the 2nd group decreased to 3.6%, the difference was not statistically significant. Evident improvement of the results was apparent in emergency operations for ruptured AAA. The mortality rate in the 1st group of 76% dropped to 40% in the 2nd group (p < 0.05). The improved policy in the management has lead to statistically significant decrease of the MI incidence in the perioperative period (87.2% to 28.5%, p < 0.001). CONCLUSION: The improved diagnostics, selection of patients with special concern to the CHD and management of the patients before surgery, improved surgical techniques and intensive care lead to evident improvement of the results in the surgical management of the AAA. This fact is confirmed by improved results of the 2nd group of patients because of improved CHD management algorithm. (Tab. 5, Fig. 1, Ref. 35.)

[Prevention and treatment of prosthesis-related sepsis in vascular surgery]. / Prevencia a liecba protetickej sepsy v cievnej chirurgii.

BACKGROUND: The first synthetic vascular prosthesis have been implanted 47 years ago. 5 years after have been referred the first aortoenteric fisula in connection with the synthetic vascular prosthesis implantation. MAIN PURPOSE AND STARTING POINTS (OBJECTIVES): The incidence of the infection and septic postoperative complications after vascular surgery was relatively high in the past. Several authors note a reduction in the incidence with experience. Another change has been widely noted recently concerning the incidence of various strains of bacteria isolated from the infected tissue and infected prostheses. The most common strain at present is St. epidermidis, known in the past as a saprophyte. There have been also changed the methods of diagnosis and the management policy. The authors of the present paper has been tried to summarize the knowledge in this field on the background of their own experience. They have summarized the clinical classification, bacteriology and the pathophysiologic mechanism of the infection, the most common clinical features, basic diagnostic possibilities, prophylactic and therapeutic policy in the postoperative septic complications, as well.

A modified supraclavicular approach for resection of a subclavian aneurysm.

The incidence of right aneurysms of the innominate or subclavian arteries is not very high. The majority of these aneurysms is placed in the distal segment of subclavian arteries. These aneurysms are involved in the complex of the thoracic outlet compressive neurovascular syndrome, especially in occurrence of the cervical rib. All aneurysms in this region can rupture and embolize. This is the main purpose of surgical management of this clinical entity. The aim of this study is to refer an interesting case history of a relatively young patient with a right aneurysm of the middle portion of left subclavian artery. The patient had no known vascular risks and the aneurysm was asymptomatic, the only sign was the visible and palpable pulsating mass over the left clavicle. The aneurysms of the middle and central portion of the left subclavian artery are usually explored through the left high posterolateral thoracotomy. The authors refer their experience with the use of a modified technique of exposure--supraclavicular (or transclavicular) incision with the subperiostal resection of the medial portion of the clavicle. This approach affords excellent exposure and a safe surgical procedure. This approach has been described in 1988 by H. Machleder. The advantage of this approach is a diminished risk of surgery in comparison with the transthoracic approach. The authors suppose, however, that it can be useful in traumatic or occlusive lesions, as well.

[The role of vascular reconstructive surgery in the treatment of cerebrovascular insufficiency]. / Miesto cievnej rekonstrukcnej chirurgie v liecbe cerebrovaskulárnej insuficiencie.

BACKGROUND: Management of cerebrovascular insufficiency (CVI) is one of the greatest medical challenges in our country. Retardation in this field has been causing serious medical and socioeconomic consequences. MAIN PURPOSE AND STARTING POINTS (OBJECTIVES): In spite of existing unfavourable conditions the authors of this paper have managed to standardize their own policy in diagnosis, surgical indications and techniques. This caused substantial improvement of their results, as well as cooperation with the neurologic clinics. In connection with the increasing numbers of operations and improved results, the authors report their recent experience in this field and compare them with the results from previous years. METHODS: The authors compare two series of patients. The first series of 65 consecutive patients surgically treated from 1st Jan. 1987 to 31st Dec. 1990 (69 operations altogether). The 2nd series of 169 consecutive patients surgically treated from January 1st 1993 to December 31st 1994 (191 operations altogether), 149 due of them were subjected to carotid endarterectomy (CEA). Mean age of the first series was 55.3 (35-73), 2nd series 59.7 years (42-86). The authors have studied participation of neurologically and angiographically unstable patients. In the first series the ratio of neurologically stable and unstable patients was 63.4:36.6%, while in the 2nd series it was 75.4:24.6%. The ratio of angiographically stable and unstable patients was in the 1st series 60.2:39.8%, while in the 2nd series it was 50.3:49.7%. In the 2nd series the authors observed also the percent age of ulcerated lesions in the carotid bifurcation and found a surprisingly high number-59.2%. RESULTS: The combined mortality-morbidity index of the first series was 11.6%, of the 2nd series 3.1%. In the first series there were two deaths (2.9%) and 6 brain infarctions. In the 2nd series four patients died from acute myocardial infarction (2.1%) and there were two cases of a perioperative brain infarction, respectively. The necessity of wound revision due to of bleeding was found in two patients (2.9%) in the first series, and in two cases (1%) in the 2nd series. CONCLUSIONS: The authors emphasize the complicated nature of these problems, the necessity to recognize the surgical indications and techniques, and protective measures to prevent serious complications. There is, in their opinion, inevitable to increase bringing the patients in need of surgical reconstruction under control. On the other hand, there is the necessity to increase the accessibility of qualified surgery in the CVI. That means in the first place to increase the number of centers able to accomplish these operations with minimal combined mortality-morbidity index. (Tab. 10, Ref. 37.).

[Aneurysms of the extracranial supraaortic vessels--8 years' experience]. / Aneuryzmy extrakraniálnych supraaortálnych vetiev--8-rocné skúsenosti.

BACKGROUND: There has been an obvious evidence of a rising incidence of the supraaortic arteries aneurysms during the last 10-15 years. It is probably the consequence of both improved diagnostics and surgical technique. MAIN PURPOSE AND STARTING POINTS (OBJECTIVES). Because of a relatively high incidence of this group of aneurysms the authors of this paper analyzed their own patients population. METHODS: From 1st Jan. 1987 to 31st Dec. 1994 10 patients were admitted 10 patients with altogether 11 supraaortic trunk aneurysms. Last year 5 patients with 5 aneurysms (45 percent) were admitted. The mean age of all patients was 57.5 (20-88) years. The mean age in the group of carotid artery aneurysms was 75.2 (71-88) years, and 31 (20-43) years in the group of subclavian artery aneurysms, respectively. Both carotid and subclavian arteries aneurysms were managed by the same technique--aneurysm resection and graft interposition. There were two exceptions. One of them was a young woman with a small asymptomatic subclavian artery aneurysm in connection with the thoracic outlet syndrome. The aneurysm has been left in its place and followed up. The second exception was a young man with a posttraumatic false aneurysm of the intrathoracic part of the right subclavian artery. He died without surgery because of massive haemorrhage due to the a false aneurysm rupture. MAIN RESULTS: The hospital mortality of the group of operated patient was zero. There has been one head nerve injury in this group and 100 percent immediate patency, as well. All patients have been followed up. There have been found an asymptomatic internal carotid artery occlusion, the rest of reconstructions has been functioning. CONCLUSIONS: The aneurysms of the extracranial supraaortic arteries are rare vascular lesions. They have, however, a high incidence of unfavorable sequelae, most of them of neurologic nature. The authors emphasize the importance of proper diagnosis and early surgical intervention in selected cases put into the hands of an experienced vascular surgeon. (Tab. 2, Fig. 1, Ref. 17.).

Evaluating materials used for constructing soft earmoulds.

The use of penetrometry for the assessment of materials employed for soft earmoulds is investigated. Selected test conditions are used for the characterisation of 10 materials of five types (cold-cured methacrylate, heat-cured methacrylate, heat-cured silicone, polyvinyl chloride co-polymer and polyethylene copolymer) used in clinical practice. The results are compared with the outcome of subjective assessments surveyed for four representative materials. The effect of ageing is assessed for a heat-cured silicone (Molloplast B) and a heat-cured methacrylate (Coe Super-Soft).