Biomedical subjects

D Veigl

Publications and source records attributed to D Veigl.

5 recordsLinked to original sources

PubMed2006

Resistin in rheumatoid arthritis synovial tissue, synovial fluid and serum.

BACKGROUND: Resistin is a newly identified adipocytokine which has demonstrated links between obesity and insulin resistance in rodents. In humans, proinflammatory properties of resistin are superior to its insulin resistance-inducing effects. OBJECTIVES: To assess resistin expression in synovial tissues, serum and synovial fluid from patients with rheumatoid arthritis, osteoarthritis and spondylarthropathies (SpA), and to study its relationship with inflammatory status and rheumatoid arthritis disease activity. METHODS: Resistin expression and localisation in synovial tissue was determined by immunohistochemistry and confocal microscopy. Serum and synovial fluid resistin, leptin, interleukin (IL)1beta, IL6, IL8, tumour necrosis factor alpha, and monocyte chemoattractant protein-1 levels were measured. The clinical activity of patients with rheumatoid arthritis was assessed according to the 28 joint count Disease Activity Score (DAS28). RESULTS: Resistin was detected in the synovium in both rheumatoid arthritis and osteoarthritis. Staining in the sublining layer was more intensive in patients with rheumatoid arthritis compared with those with osteoarthritis. In rheumatoid arthritis, macrophages (CD68), B lymphocytes (CD20) and plasma cells (CD138) but not T lymphocytes (CD3) showed colocalisation with resistin. Synovial fluid resistin was higher in patients with rheumatoid arthritis than in those with SpA or osteoarthritis (both p<0.001). In patients with rheumatoid arthritis and SpA, serum resistin levels were higher than those with osteoarthritis (p<0.01). Increased serum resistin in patients with rheumatoid arthritis correlated with both CRP (r=0.53, p<0.02), and DAS28 (r=0.44, p<0.05), but not with selected (adipo) cytokines. CONCLUSION: The upregulated resistin at local sites of inflammation and the link between serum resistin, inflammation and disease activity suggest a role for resistin in the pathogenesis of rheumatoid arthritis.

Adult↗

PubMed2006

Periprosthetic osteolysis and its association with RANKL expression.

Extensive osteolysis adjacent to orthopedic implants is often associated with wear particles of prosthetic material. The activation of the RANKL/RANK/OPG system is considered to be a likely cause of periprosthetic osteolysis leading to implant failure. The aim of this study was to examine the possible correlation between the clinical extent of osteolysis, the number of wear particles and expression of the osteoclastic mediator RANKL (receptor activator of nuclear factor kappa B ligand) in the tissues around aseptically loosened cemented and non-cemented total hip replacements. Periprosthetic tissues were harvested from 59 patients undergoing revision of hip replacement for aseptic loosening. We observed RANKL-positive cells in 23 of our 59 patients, their presence was noted predominantly in tissues with a loosened cemented endoprosthesis. We have found that RANKL is present only in tissues with a large amount of wear debris and predominantly in cases involving loosened cemented implants.

Aged↗

PubMed2004

[Ten years' experience with our method of wrist joint arthrodesis].

PURPOSE OF THE STUDY: Total arthrodesis of the carpal joint is a complex operative procedure that results in the restoration of joint stability in frontal and sagittal planes and improvement in function of the tendons of digits' extensors and flexors. We developed our own method based on the use of a special implant; in this study we report our long-term results. MATERIAL: Since 1992 we have carried out 54 total carpal arthrodeses, using our method, on 51 patients; three patients were treated bilaterally. Both wrists were treated in. This group comprised 34 women and 19 men, with the average age of 47.6 years. We used the modified method mainly in patients with stage IV rheumatic carpal destruction (Larsen classification) or in those with wrist destruction due to arthritis or psoriasis. In two patients, this method was indicated because of a non-reparable lesion of the nervus radialis. It was also used in two patients who had their wrist replacements removed due to failure. METHODS: The procedure was carried out, with a tourniquet applied to the upper arm, from the dorsal approach to the carpal joint. After opening the capsule, using an oscillating saw, we resected the facies articularis radii, the carpal bones, which were freed from cartilage and turned into a cancellous in situ filling, and the distal ulna. This procedure prepared the operation field for the application of our plate. This L-shaped plate, only 2 mm thick, with its concave curve fitting the palm, allows for three-point fixation of the metacarpal region and also maintains slight compression. RESULTS: In all the patients, we achieved osseous fusion detectable by radiography and clinical examination on average at 12 weeks postoperatively. The grasping function of the hand improved in all patients because the carpal axis was adjusted to a functionally convenient position. The resection of the distal ulna, which is a part of our method, removed pain caused by supination or pronation. The patients reported the absence of pain, instability and edema of the wrist. DISCUSSION: The aim of any method for total wrist arthrodesis is the firm fixation of resection-treated articular surfaces of the radius, carpal bones and metacarpal bases for a period long enough to allow for their complete fusion. These techniques involve intraosseous procedures, the use of plates, osteorrhaphy and external fixation. Most of these methods use massive corticocancellous grafts collected from the hipbone crest. The critical point of all methods is fixation of the metacarpal region. CONCLUSIONS: The method described here is based on an original implant in the form of an L-shaped plate that permits sufficient fixation without using grafts taken from the pelvis. In patients with rheumatic arthritis, if needed, it facilitates peritenosynovectomy or reconstruction of spontaneous tendon ruptures in one operation. It does not require long-term immobilization in plaster cast and permits early rehabilitation of finger joints.

Arthrodesis↗

PubMed2003

[Polyethylene disease].

PURPOSE OF THE STUDY: The experience obtained during revision surgery and findings of polyethylene granulomas in surrounding tissues of replacement as well as marked differences in the viability of implants resulted in the study of polyethylene disease and its basic mechanisms producing the development of osteoaggressive granulomas. We investigated the morphology of particles and their number in tissues surrounding the implant. The aim of our study was to develop a method for the detection of polyethylene particles in tissues, to identify different types of wear and to assess factors that may influence the viability of joint arthroplasty in general. MATERIAL: Every revizion of joint arthroplasty performed during the last five years was evaluated in terms of the presence of polyethylene granules and the viability state of articular polyethylene inserts. A total of 55 samples were taken from tissues around loosened endoprostheses. The location of each sample was exactly determined. METHOD: A technique was developed to identify wear particles and to visualize them after all organic structures of a polyethylene granuloma were dissolved with nitrogenic acid. RESULTS: The viability of articular polyethylene implants showed extreme differences in relation to different periods of manufacture and probably also to different methods of sterilization. Articular inserts sterilized with formaldehyde (the method used at the beginning of arthroplasty in our country) showed the highest viability and the lowest wear. The polyethylene particles present in tissues surrounding the implant were characterized in terms of morphology and size. DISCUSSION: The comparison of literature data and our results has revealed that there are many unknown facts about the quality and structure of polyethylene. The method of sterilization also appears to play a role. Because the issue is complex, we were not able to identify all factors leading, in some cases, to an early and unexpected failure of the implant and we consider further investigation to be necessary. CONCLUSIONS: Polyethylene disease is an important factor limiting the viability of joint arthroplasty. It results from a complex interaction of polyethylene particles arising by wear with surrounding tissues. The particles, less than 0.5 micron in size, are phagocytized by macrophages and, by complex mechanism of expression of inflammation mediators, they result in the inhibition of osteogenesis and activation of osteoclastic processes. The previous methods of sterilization with formaldehyde vapors apparently reduced wear influenced the resistance of polyethylene to wear to a lesser degree. A method was developed to detect these particles and to characterize their morphology in the tissues of a polyethylene granuloma.

Foreign-Body Reaction↗

PubMed2003

[Deformities of the forefoot in patients with rheumatoid arthritis--results of surgical treatment].

PURPOSE OF THE STUDY: Rheumatoid arthritis affects the foot very frequently. The transversal arch of the foot gradually declines due to the inflammation, the metatarsal heads protrude in the sole of the foot which is accompanied by painful bunions and sometimes also skin necrosis. The great toe turns into a valgus position and pronation. Walking is very painful. MATERIAL: The authors evaluate a group of patients operated on for the deformities of the forefoot between 1995 and 2002. METHODS: In the deformities of the forefoot the authors use resection of the heads of II-V metatarsals. They use a plantar surgical approach during which they remove bunions under the heads of the metatarsals. Then they gradually perform resection of the heads of--V metatarsals. In case of the great toe they prefer resection after Keller. In 5 cases they used fusion of the MTP joint of the great toe. They use fusion only in cases of a marked valgus position of the great toe. Where I MTT was in a significantly varus position, they applied in 3 cases the Lapidus procedure. RESULTS: Between 1995 and 2002 they operated on 92 patients, in 38 of them the surgery was performed bilaterally. Evaluation covered 130 surgeries. In 85 cases the patients had rheumatoid arthritis, in 7 the basic diagnosis was psoriatic arthritis. The group included 72 women and 20 men. The average age at the time of surgery was 38.4 years. Eighty-two (63.1%) patients were without pain 7 (5.4%) patients had severe pain. The authors monitored the occurrence of revalgization of the great toe after Keller resection arthroplasty--of 77 patients revalgization occurred in 23 cases (29.8%). The complications included 3 times a late infect 1-2 years after the surgery after the protrated infect of the organs, 3 times a skin necrosis between the great toe and 2nd metatarsal, when prior to the surgery there was a significant valgus deformity and after the correction of the great toe there was a skin tension in this region, 6 times a delayed healing of the wound on the sole of the foot. DISCUSSION: The authors present different surgical techniques of the forefoot and the great toe of the foot used by different authors. CONCLUSION: As the patients suffer from a polyarticular affection the emphasis is put on the individual approach and a properly timed operation. In this respect of vital importance is the cooperation involving a rheumatologist, orthopaedic surgeon, physical therapist and prosthetic department. Orthopaedic insoles and orthopaedic shoes are an integral part of the comprehensive therapy. Surgical treatment is not very demanding for patients and in most cases it brings a significant relief.

Adult↗