Biomedical subjects

S Popelka

Publications and source records attributed to S Popelka.

At least 19 recordsLinked to original sources

PubMed2006

[Three-dimensional geometry of the proximal humerus and rotator cuff attachment and its utilization in shoulder arthroplasty].

PURPOSE OF THE STUDY: The aim of the study was to provide a method of measurement and data collection, based on morphologic analysis of the proximal humerus, that would facilitate precise placement of the humeral stem and would be easy to apply in clinical medicine in patients requiring shoulder arthroplasty. MATERIAL: Three groups of materials were used. Materials for the first and second groups were provided by the Department of Anatomy, First Faculty of Medicine, Charles University. The first group included 10 specimens (five left and five right humeral bones) obtained at routine anatomical dissection. The second group contained 110 so-called dry preparations from the collections of the Department of Anatomy and the third group comprised nuclear magnetic resonance (NMR) scans of 20 patients. To show spatial relationships between the proximal and the distal humerus, another coil was applied to the epicondylar region in addition to the one placed over the proximal humerus. METHODS: The first group material was used to study proximal humerus morphology and to determine reference points for the other two groups. The points were constructed to make seven planes perpendicular to the axis of the proximal humeral metaphysis. Based on the reference points, parameters of the proximal humerus were assessed in the defined planes also in the other two groups. We measured angles between the reference points and the transepicondylar line or the humeral head axis. The vertex of each angle was always placed in the point of intersection of the metaphyseal axis and the given transverse plane. Reference points of the greater tubercle were marked on the medial margin continuous with the intertubercular groove, on the lateral margin of the lesser tubercle and in the "deepest" place of the intertubercular groove. We also measured humeral head retroversion and the position of maximal bony mass of both the greater and the lesser tubercle (this parameter can be used with advantage for optimal insertion of screws in proximal humerus reconstruction). RESULTS: The angle between the medial margin of the greater tubercle and the humeral head axis was on average 164.8 degrees on the left side and 163.2 degrees on the right side; the angle between the great tubercle margin and the transepicondylar line was 137.0 degrees on the left humerus and 137.7 degrees on the right humerus. The lateral margin of the lesser tubercle and the humeral head axis formed on average an angle of 124.4 degrees and of 122.6 degrees on the right and the left side, respectively. The intertubercular groove/ humeral head axis relationship was 143.4 degrees and 144.8 degrees for the left and the right humerus, respectively, and the intertubercular groove/transepicondylar line angle was 115.6 degrees for the left and 119.5 degrees for the right humerus. The humeral head axis and the transepicondylar line made an angle of 27.8 degrees for the left and 25.3 degrees for the right humerus. These values corresponded to the angle of the humeral head retroversion. The reference point of maximal bony mass of the greater tubercle and the humeral head axis made an angle of 181.1 degrees and of 180.2 degrees for the left and the right humerus, respectively; between this point and the lesser tubercle was an angle of 120.2 degrees for the left and 126.9 degrees for the right humerus. DISCUSSION: One of the most important parameters in restoring shoulder function by alloplasty is humeral head retroversion. If this is not correct, ventral or, less frequently, dorsal instability of the shoulder may result. The correct setting of retroversion is guided by the transepicondylar line or several specific landmarks on the greater and the lesser tubercle of the humerus. Another important factor is the correct reconstruction of anatomic position of the greater and the lesser tubercle in relation to the insertion of rotator cuff muscles into the humeral head. Relationships of diaphyseal, metaphyseal and humeral head axes have been reported in the relevant literature dealing with proximal femoral morphology. None of the reports, however, has dealt with tubercular angles and position of the maximal body mass, which is a decisive factor for insertion of screws fixing the prosthetic stem. CONCLUSIONS: The values provided here can be used for a more precise construction of implants for shoulder replacement. The method of three-dimensional presentation of the proximal humerus may aid in a more exact implantation procedure during shoulder arthroplasty. An optimal position of the implant can also be based on parameters obtained from the healthy contralateral shoulder joint.

Anthropometry↗

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

[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↗

PubMed2001

[Aprotinin (Antilysin Spofa)--its effect on decreasing hemorrhage in the postoperative period in hip arthroplasty].

PURPOSE OF THE STUDY: Aprotinin is a non-specific inhibitor of serine proteases with hemostyptic and hemostatic properties. The effect covers suppression of fibrinolysis and support of the role of thrombocytes in coagulation. In a prospective randomized study we verified whether the application of aprotinin (Antilysin Spofa, Czech Republic) in the dosage effective in cardiosurgical patients reduces blood loss and the need for blood transfusion for orthopaedic patients. MATERIAL: 42 patients indicated to the primary THA were randomly selected into the study and control groups. Excluded were allergic patients and those who used aprotinin before. METHODS: Administration of 2.10(6) KIU of aprotinin was started preoperatively and is continued in the course of the first hour of surgery. In the operated on patients we recorded prior to operation and in the first post-operative morning the level of hemoglobin in blood and hematocrit, the number of infusions and blood transfusion units administered in the course of the surgery and in the post-operative period until the first post-operative morning. We recorded blood loss in the period between the surgery and the first post-operative morning. Data acquired in the patients of the studied and control groups were compared by means of ANOVA test for repeated measuring and with the use of Mann-Whitney and chi 2-test, the level of significance p < or = 0.05. During the hospitalization we the patients were checked for symptoms of deep venous trombosis and tromboembolic or other adverse events. RESULTS: Hemoglobinemia and hematocrit in both groups significantly decreased after the operation (p < 0.0005), the differences between the studied and control groups were not significant. The number of administered blood units did not differ in the examined and control groups. The frequency of blood transfusions was postoperatively higher in the control group (59.1% as compared to 30%), however, the difference was not statistically significant (p = 0.059). Blood loss in the post-operative period was higher in the control group (p = 0.048). Patients from the control group got in total blood transfusion more frequently (p = 0.032). Differences in the total frequency of blood transfusion and in the amount of post-operative blood loss were statistically significant. In the course of hospitalisation no signs of deep phlebothrombosis or thromboembolic condition were encountered in either group of patients. Complications were not recorded. DISCUSSION: Our results correspond with most of the published data. Blood loss of the operated on patients who were administered prior to and at the beginning of the operation in total 2.10(6) KIU of aprotinin (Antilysin Spofa) in infusion was on average by 33% less in the post-operative period and in the whole peropetive period they required less frequently blood transfusion (40% vs 73%). CONCLUSION: Infusion of aprotinin (Antilysin Spofa) in the dosage of the order of 106 KIU significantly reduces post-operative blood loss and frequency of transfusion in the peroperative period in patients undergoing THA.

Aprotinin↗

PubMed2001

[A rare case of extensive bilateral polyethylene granuloma after knee replacement].

The authors present a case of bilateral loosening of total knee arthroplasty as a result of polyethylene (PE) wear. Five and seven years after TKA the patient developed a polyethylene granuloma leading to extensive bone defects under the implant. Finally it resulted in pathological fracture of medial condyle of tibia. A revision PFC stabilized prosthesis was used for reimplantation. Bone defects were filled in by bone grafts from the bone bank. Authors point out the issues of PE wear. In the discussion they list various factors (time, indication, material, design and the factor of individual response of the organism) which may play an important role in the incidence of PE wear. The incidence of polyethylene granuloma in TKA is still a rare complication, however, it is necessary to take this issue into account as the number of such cases will undoubtedly grow.

Aged↗

PubMed1996

Influence of transference number on migration and deformation of concentration boundaries in capillary zone electrophoresis.

The change of the position and shape of a concentration boundary existing in the background electrolyte in capillary zone electrophoresis is treated theoretically. Such boundaries may occur when the ionic concentration, c, of the sample differs from that of the background electrolyte. Both mathematical treatment and numerical simulation lead to the result that when an (initially symmetrical) concentration boundary migrates in the capillary it becomes nonsymmetrical. The reason for this is the nonsymmetry of the function, which is obtained as the difference of the transference number (which is a function depending on c) and its linear approximation at the average value of the concentration. Numerical simulations for capillary zone electrophoresis with LiI or potassium benzorate as a hypothetical background electrolyte show the formation of asymmetrical plugs for samples of more diluted electrolyte solutions.

Computer Simulation↗

PubMed1992

[130 years of the Czech Medical Society in Prague].

The author reminds that 130 years ago the Czech Medical Society in Prague was founded. He mentions the difficulties which proceeded this historically important event during the Austrian monarche where the leading language was German and all attempts to introduce Czech into public life were impossible. The author mentions the names of those with the greatest merits as regards the foundation of the Society: J. E. Purkynĕ, B. Eiselt, J. Podlipský and E. Grégr who achieved after repeated attempts that the foundation of the Society was granted and its activities were started in July 1862. The first elected chairman was Jan Evangelista Purkynĕ. The author mentions briefly also the activities of the Society during the German occupation and subsequent years. If in 1862, the time of foundation, the Society had only 150 members, at present it has 1500 members and is not only the oldest but also the largest medical society in this country.

Czechoslovakia↗

PubMed1990

[Long-term results of Ludloff's repositioning method].

Authors have evaluated results of the surgical treatment of congenital dysplasia of the hip joint performed at I Orthopaedic Clinic in Prague in the years 1970-1985. In the course of this period open reduction according to Ludloff was performed in seventy children out of which eight times bilaterally. Fifty-six out of the total number of seventy children same for the follow-up check. The age of the children operated on ranged between five and 23 months; in six cases the operation was performed on both hip joints. The follow-up ranged from three to eighteen years with an average of eleven years. In all children the postoperative treatment consisted in the application of the Hanausek biomechanical apparatus. On the basis of clinical and roentgenological criteria the results were divided into fair and poor results. For fair result were considered the hips with a good range of motion (none of the motions was reduced more than by 50 percent of the normal range), patients did not feel any pain, the limb shortening did not exceed 1 cm and the Trendellenburg test was negative. From the roentegonological viewpoint for fair were considered the findings without persisting subluxation and dislocation with the spheric head (the asphercity on the Moose template did not exceed 2 mm) and without evident shape deformities of the proximal end of the femur (coxa vara, overgrowth of the greater trochanter). Only such hips which meeted both the clinical and roentgenological criteria were evaluated in general as fair, the other were assessed as poor. On the basis of these criteria the result of the treatment was evaluated as fair in 76 percent and poor in 24 percent of cases. The authors also observed the incidence of aseptic necrosis of the femoral head from the viewpoint of the types defined by Bucholz and Ogden. Necrosis of Type I was not found in the group, necrosis of Type II occurred 12 times, necrosis of Type III and Type IV three times each. No evident connection was found out between the incidence of the necrosis of head and the ligation of both branches of a. circumflexa femoris medialis. The main cause of the impossibility to perform reduction was the isthmus of the joint capsula in its inferomedial portion in the area of iliofemoral ligament. Of decisive importance for the development of the joint after open reduction was a perfect reduction of the head into acetabulum.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMed1990

[Surgical treatment of patients with juvenile cerebral palsy at the orthopedic clinic of the Charles University Medical School in Prague-Motol].

In the period of 1976-1987 there were in total 181 patients operated on with the diagnosis of infantile cerebral palsy at the Orthopaedic Clinic of the Faculty of Pediatrics of Charles University in Prague-Motol. 412 operations were performed in total in these patients. The indication was mainly the improvement of the statics and gait, therefore operations on lower extremities prevailed. Within the preoperative preparation it is essential to precisely classify the type of affection of the patient from the neurological viewpoint and mainly estimate the future physical and psychical abilities of the child which is of substantial importance in the postoperative treatment. The surgical solution is always individual and respects the specificity which need not be symmetric on both extremities. Therefore the range of orthopaedic operations is wide. The surgeon has to treat the equinus position of the foot, the valgus position, flexion contractures of knees, adduction position in hip joints. In case it is necessary to operate the affection of the entire lower extremity the specialists at the above mentioned Orthopaedic Clinic prefer a single solution to the stepwise one. Recently the surgical treatment of patients suffering from spasm has achieved a certain progress. Substantial is the contribution for patients who on the basis of the operation regain the ability to walk. Therefore the authors emphasize the importance of the cooperation of the neurologist and the rehabilitation worker with the orthopaedic surgeon when considering comprehensive therapeutical possibilities.

Cerebral Palsy↗

PubMed1989

[Classification of deformities of the glenoid labrum in congenital hip dislocation].

The authors have developed their own classification of the deformities of labrum glenoidale in congenital hip dislocation. Open reposition was performed by the Ludloff procedure. The basic material for their work was the group of patients operated on at I. Orthopaedic Clinic of the Faculty of General Medicine of Charles University in Prague in the years 1970-1985. In the course of this period they operated on 78 hip joints in 70 children, out of which 8 operations were bilateral, the group comprised 17 boys and 53 girls, operation was performed on 30 right hip joints and 48 left ones. The age of children ranged from 5 to 23 months. The average age of children in time of operation was 9.3 months. On the basis of the cadaver material the authors have found out that glenoidale represents an extensive part of acetabulum. Labrum glenoidale is considerably more sizable in the dorsal parts of acetabulum so that the head seems to be completely enveloped by ligamentary limbus and the acetabulum seems to form at least half of the ball-shaped surface. In the dorsal and upper parts the acetabulum is from great part formed by a fibrous structure which is easily deformed. The pressure applied to the head dorsally can result in its dislocation just because the cartilaginous model of acetabulum is flat in its dorsal and proximal parts. This easily deformable structure is under certain conditions deformed by pressure of the head in such a way that in the first phase in the course of the onset of the dislocation it is always everted and in the second phase the evertion lither persists or the head shifts over the margin of the limbus and the limbus is then inverted by reposition force. The authors present in their work the classification of the limbus. Proceeding from operation findings they divide limbi into four groups according to differences in their shape: Type I: regularly annular (everted) limbus--it corresponds to a normal anatomic shape, it is not pronouncedly deformed and does not present an impediment to reduction. Type II: inverted gracilis limbus--it is exaggerated in comparison to the normal one, usually it is inverted in the acetabulum, it is never rigid but elastic. Together with the structure of capsule it can be an impediment to reduction. It can be relatively easily everted. Type III: inverted callous limbus--it is sizable, rigid, reducing by its position the capacity of the acetabulum. The reduction is usually difficult.(ABSTRACT TRUNCATED AT 400 WORDS)

Acetabulum↗

PubMed1989

[Initial experience with the Steel triple osteotomy in the treatment of arthrosis of the hip joint as a result of congenital hip dysplasia].

The age of the patients was 18 to 40 years (mean age 32 years), the interval after operation was 5 months to 3 years (mean 17 months). In all 8 patients proper covering of the head was achieved, CE angle 25-45 degrees, mean gain of CE angle 35 degrees. The X-ray picture revealed widening of the articular space and reabsorption of arthritic pseudocysts. As regards the clinical picture, marked regression of complaints was recorded. Osteotomy of the pelvis according to Steele prolongs the vitality of the hip joint: a) by increasing the contact surface in the hip joint, b) by shifting the till then minimally burdened and thus minimally usurated cartilage into the zone of the main burdening, c) the usurated cartilage, on the other hand, is shifted beyond this zone. Moreover, osteotomy of the pelvis prepares a bed for anchoring of the cup of a possible future prosthesis. The above facts are advantages, as compared with different types of osteotomies of the femur, which moreover may in future cause further complications of the implantation of the femoral component of the artificial joint.

Adolescent↗

PubMed1988