Biomedical subjects

P Janícek

Publications and source records attributed to P Janícek.

11 recordsLinked to original sources

PubMed2006

[Cementless ceramic-on-ceramic total hip system].

PURPOSE OF THE STUDY: This is an experimental and clinical study on the use of cementless, ceramic-on-ceramic total hip arthroplasty (THA). MATERIAL AND METHODS: In the experimental part, the authors constructed, by means of mathematical analysis of finite elements, surface tension standards for the ceramic liner at various angles of cup inclination, and identified potentials for destruction of the liner. In the clinical trial, they evaluated the outcomes in 50 patients, out of the 249 implanted prostheses, at five-year follow-up. RESULTS: The experiment showed that a slightly steeper inclination the cup provided physical conditions for increased longevity of the ceramic liner. In the clinical study, no post-operative complications, such as fracture of the acetabulum or femur, and dislocation or break of any ceramic part, were recorded. No infection or loosening of the prosthesis occurred. The patients did not complained of any pain in the hip joint, which is typical of non-cemented THA. DISCUSSION: Ceramic-on-ceramic bearing surfaces show the least wear due to high biocompatibility. Computer-assisted surgery can markedly reduce the risk of incorrect positioning of the acetabular component. In this prospective study, the five-year survival of ceramic-on-ceramic THA in 50 patients free from any complications, whose Harris hip score was 97.4 points, suggests that objections to these prostheses, as raised by some authors, are not justified. CONCLUSIONS: In our experience the Plasmacup Bicontact ceramic-on-ceramic prosthesis is one of a few options that has a prospect of remaining the only total hip replacement in one's lifetime. Key words: total hip replacement, ceramic-on-ceramic.

Arthroplasty, Replacement, Hip↗

PubMed2004

Perioperative fractionated high-dose rate brachytherapy in the treatment of soft tissue sarcomas.

The purpose of the study was to investigate the viability of perioperative fractionated high dose rate brachytherapy (HDR BT) for primary and reccurent soft tissue sarcomas (STS). From February 1998 through June 2002, 21 adult patients, 11 females and 10 males with either low grade or high grade soft tissue sarcomas were treated by perioperative HDR BT. Surgical margin was negative in 10 cases, close in 4 and positive in 4 in cases. In 3 cases it was not described. BT was used as a part of primary treatment in 10 cases and for the treatment of reccurent tumor in 11 cases. The localisation of the tumor was the extremity in 16 patients and the trunk in 5 patients. Ten patients were treated with HDR BT alone (total mean dose 40 Gy) and 11 were treated with combination of external beam radiotherapy (EBRT) (40-50 Gy) and brachytherapy (total mean dose 24 Gy). Hyperfractionation 2.4-3 Gy twice daily at 10 mm from the source was used for BT. Follow-up periods were between 7--48 months (median: 20 months). Local control in patients treated pro primary STS was 100%.The pulmonal metastases were a cause of death in one case, one patient was alive with dissemination and one patient was disease free after salvage surgery and chemotherapy for lung metastases. Local control was achieved only in 3 of 11 patients treated for reccurent tumor (27%). Six patients were disease free after salvage surgery, 2 patients died of disease progression, one patient died of toxicity of chemotherapy without evidence of disease and 2 patients are alive with distant metastases. Local control was achieved in 5 of 11 (45%) patients with positive, close or not stated surgical margin and in 5 of 10 (50%) patients with negative margin. Local control was 100% in patients treated by EBRT + BT, but only 20% in patients treated by BT alone. No infection or delayed wound healing has occurred after BT. Soft tissue necrosis was seen in 4 cases, subcutanous fistula in one case and peripheral nerve palsy in one case. Despite small number of patients and short follow up our study suggest that perioperative HDR BT is easy and promissing when used as a part of primary treatment for STS. The treatment results for recurrence are poor and in a lot of cases radical surgical approach should have been considered for the salvage.

Adult↗

PubMed2003

[Disarticulation of the knee joint].

PURPOSE OF THE STUDY: The authors report their experience with exarticulation in the knee joint, describe the relevant surgical procedure, assess the outcomes of different modifications of the surgical treatment and emphasize the advantages of the stump following exarticulation in the knee joint. MATERIAL: The sample included 19 patients, 13 women and 6 men, operated on in the period from 1987 to 2001. One of the women had bilateral surgery. Their average age at the time of surgery was 48 years, the range was 5 to 82 years. In most of the patients, exarticulation in the knee joint was indicated because of a malignant tumor in the crux region that could not be treated by any radical but, at the same time, limb-saving procedure. Other indications included an infected allograft of the tibia, chronic osteomyelitis of the tibia complicated by spinocellular carcinoma in a fistula, a stump after high amputation in the tibia that could not be fitted with a prosthesis, chronic lymphedema and diabetic microangiopathy. METHODS: Exarticulation is an amputation of the peripheral part of a limb in a joint, i.e., without cutting bone. The authors used a modified Rogers' procedure. Under the use of a tourniquet, a ventral incision, 10 cm long, was run from the articular fissure level distally and a dorsal incision, 5 cm long, was cut distal to the articular fissure. This produced a longer ventral and a shorter dorsal flap. The subsequent procedure included the discission of the ligamentum patellae at the tibial attachments, the articular capsule, m. sartorius, m. gracilis, m. semitendinosus, m. semimembranosus and biceps femoris, all cut at their distal attachments, as well as the tractus iliotibialis. The collateral and cruciate ligaments were incised at their femoral attachments. After dissection of the neuro-vascular bundle, the vessels were incised and double ligated. The n. tibialis and n. peronaeus were infiltrated with mesocaine and cut through. Then the m. popliteus, ligamentum popliteum arcuatum and the two heads of the m. gastrocnemius were incised and the crux separated. After removal of the pneumatic tourniquet, bleeding was arrested. The condyles, patella and synovialis were left intact. The ligamentum patellae was sutured to the tendons of the m. semimemranosus, m. semitendinosus and biceps femoris. The m. satorius and m. tractus iliotibialis were sutured to the extensor apparatus. The layer after layer was sutured with individual stitches and two Redon's drains were inserted below the fascia. RESULTS: Five patients were referred back to the initial hospital. Of six patients who died, five developed complications due to dissemination of the underlying malignant disease and one died of causes unrelated to the major disease. Eight patients were followed up at regular intervals. Of these, seven were satisfied with their stump and only one patient complained of pressure sores and therefore changed prosthetic care. Patients' complaints that would lead to repeat operations or amputation in the femur were not recorded. DISCUSSION: The surgical technique described is fast, gentle in terms of tissue damage and relatively easy to perform. All patients in the group showed good healing. The authors point out that the stump achieved by exarticulation has good weight-bearing qualities because of a large surface controlled by strong musculature that can maintain muscular balance and control the rotation of a prosthesis. The results of this study are in agreement with the data published in the English, German and Russian literature. In the Czech literature, this issue has not been reported yet. CONCLUSIONS: The advantages of exarticulation in the knee joint are as follows: quick, gentle and uncomplicated surgical procedure with low blood losses; good potential for per primam healing; high quality of the stump surface to be fitted with a prosthesis; current availability of good quality prostheses that are easier to fit than those applied after high amputation in the crux with a stump less than 11 cm or after low amputation in the femur.

Adolescent↗

PubMed2001

[Complications with the acetabular cup in the CLS total hip joint endoprosthesis].

PURPOSE OF THE STUDY: The aim of the study is to present complications of acetabular component of CLS total hip replacement and their solution. MATERIAL: In the period of 1986-1999 in total 219 cementless CLS total hip replacements and 2012 CLS cups in hybrid replacements were implanted at 1st Orthopaedic Department in Brno--primary surgeries--2026, revision surgeries--205. Of 2231 CLS cups we encountered 25 complications requiring a revision surgery (1.1% of all cases): 2 cases of the broken metal shell, 3 cases of cup penetration into pelvis, 4 cases of cup migration, 5 cases of aseptic loosening, 5 cases of dislocations and 6 cases of deep infections. METHOD: Broken metal shells were treated by Müller and Eichler ring, cancellous bone grafting with a cemented PE cup. Penetration of cups into pelvis were managed by Girdlestone procedure. Migration of the cup was solved in 1 case by Burch-Schneider ring, other cases with a good function were left in situ. Aseptic loosening with defects of acetabulum was solved by means of metal rings, cancellous bone grafting and cemented PE cup. Dislocation was managed by adjustment of CLS cup in the correct position, longer or closed reduction and orthesis. In infections a two-step procedure was used with a repeated application of CLS cup, Prostalac technique or Girdlestone procedure. RESULTS: The results of cases solved by means of acetabular metal rings, cancellous bone grafting and cemented PE cup are after 2-5 years good. The patients are capable of full weight bearing and have no pains, Harris score is 83-89 points. The radiograph shows in all but one patients a stable implant without radiolucent interface. The function of all patients with dislocations of CLS implant is now very good or good. No recurrence was recorded in patients with infections. The function of the hip with Girdlestone procedure is in 2 patients low--Harris score is 58 and 63 points. Harris score in patients after a two-step revision with a repeated application of CLS cup is 80-89 points. DISCUSSION: In cases of the broken metal shell there occurred a proximolateral defect of the acetabular bone as a result of development dysplasia of the hip. The cup had inadequate circumferential support. The cases of cup penetration into pelvis are connected with a marked primary or subsequent deficiency of the acetabular floor, excessive reaming of subchondral bone and osteoporosis. Revision surgery with a metal ring requires a careful extensive cancellous bone grafting with a complete filling of all defects, support of the ring by the bone and development of a stable bone-ring-cemented PE cup composite. The best results in infections were achieved by a two-step revision with a repeated application of CLS cup. CONCLUSION: Of the total number of 2231 implanted CLS cups in the period of 1986-1999 only 25 complications were recorded requiring a revision surgery, i.e. 1.1% of all cases. Complications relating to the cup were treated in case of acetabular defects by means of metal acetabular rings, cancellous bone grafting and cemented cups. In infections a two-step procedure was used with a repeated application of CLS cup, Prostalac technique or Girdlestone procedure.

Acetabulum↗

PubMed1998

[Low grade malignant fibromyxoid sarcoma].

Two cases of low-grade fibromyxoid sarcoma are presented. In a 31-year-old male the tumour arouse in the scapular soft tissues and local recurrence occurred. In a female of 45, the neoplasm was located in the thigh. Histologically, the neoplasms with low cellularity of deceptively benign-appearing small fibroblastic spindle cells demonstrated alternating dense fibrous and loose myxoid areas, showing a mainly whorled and swirling growth pattern. In myxoid areas a prominent vascular component was present. Mitoses and cellular atypia were absent. Tumor cells showed staining with anti-vimentin and occasionally anti-actin antibodies. As a distinctive soft-tissue sarcoma, low-grade fibromyxoid sarcoma had to be distinguished from variety of benign and malignant soft tissue tumours such as neurofibroma, liposarcoma, myxoid MFH and others.

Adult↗

PubMed1990

[The preoperative radiographic image in traction and of the postural angle in relation to postoperative correction of the scoliotic curvature].

The authors evaluated a group of 297 patients after the surgical correction and stabilization of the spine, out of which there were 171 idiopathic, 98 congenital, 14 neuromuscular deformities and 14 deformities were connected with neurofibromatosis. By the statistical comparison of the values of curvature when the patient is standing prior to operation, lying in distraction of 200N and lying in side-bend to the convex of the curve with the value of correction after operation the authors have proved that it is sufficient to carry out only the examination in the maximum voluntary side-bend with the exception of the deformities of neuromuscular origin where it is necessary to perform also x-ray examination in the distraction of 200N when the patient is lying.

Female↗

PubMed1988