Biomedical subjects
Publications and source records attributed to W Marciniak.
The author presents a historical overview of the evolution of surgical treatment of congenital clubfeet, focussing in particular on the last 30 years. The paper reviews the pathological and biomechanical problems related to the surgical procedures introduced by Turco, McKay and Simons, as well as indications for procedures from a postero-lateral and Cincinnati approach.
The interaction of dioxygen with various tetrahedral aluminum alkyls, (tBu)3Al.OEt2 (1), tBu2Al(mu-OtBu)2AltBu2 (6), (tBu)2Al(mesal) (2) [mesal=methyl salicylate anion], R2Al(mu-pz)2AlR2 [pz=deprotonated pyrazole, R= Me (3a), Et (3b), and tBu (3c)], R2Al(mu-3,5-Me2pz)2AIR2[3,5-Me2pz = deprotonated 3,5-dimethylpyrazole, R= Me (4a), and Et (4b)], and Et2B(mu-pz)2AlEt2 (5), has been investigated. We were particularly interested in the effect of steric hindrances both caused by the metal-bonded substituents and those that result from the nature of the bifunctional ligand used in the oxygenation reaction. In the reaction of 1 with O2, only the formation of the monoalkoxide compound6 was observed. The latter di-tert-butyl compound as well as all planar aluminapyrazoles, that is, the tert-butyl derivative 3c and lower alkylaluminum derivatives with the more demanding 3,5-dimethylpyrazoyl ligands 4a and 4b, are stable under an atmosphere of dry oxygen and ambient conditions. Inspection of the space-filling representation of these compounds has undoubtedly shown that the bulky tert-butyl groups or pyrazolyles ligands, respectively, provide steric protection for the metal center from the dioxygen attack. In contrast, the dialkylaluminum derivatives of pyrazole, 3a and 3b, and the diethylaluminum bis(1-pyrazolyl)borate complex 5, all with the metal center eclipsed with respect to the plane defined by the four nitrogen atoms, react smoothly with O2 to form the alkyl(alkoxy)aluminum complexes. In the reaction of 5 with O2 for example, the Et-B bonds remained intact, and the dimeric five-coordinate compound [Et2B(mu-pz)2 Al(mu-OEt)Et]2 (9) was isolated in good yield. The interaction of mononuclear di-tert-butyl chelate complex 2 with O2 at -15 degrees C gives (tBuOO)(tBuO)Al(mu-OtBu)2Al(mesal)2 (7) in high yield, and the presence of the alkylperoxo moiety is a particularly significant point in the resulting product. All the compounds have been characterized spectroscopically, and the structures of 3c, 4a, 6, 7, and 9 have been confirmed by X-ray crystallography. Structural features of 1-6 are discussed and are considered in relation to the possible approach pathways of the O2 molecule to the four-coordinate metal center. This analysis and the observed apparent dissimilarity in the reactions of model four-coordinate aluminum alkyls with O2 clearly show that the stereoelectronic prerequisites are responsible for the fundamentally different reactivity.
The study presents the long-term results of operative treatment of spastic subluxation and dislocation of hip joints in cerebral palsy children with open reduction and pelvic transiliac osteotomy by Dega. The subjects were 25 patients (30 hips) and the follow-up lasted from 3 to 25 years (average 12 years). Final examinations were carried out after the end of body growth. Detailed analysis covered a patient's function, occurrence and intensity of pain in the hip joint, value of radiological parameters such as angle of centre-edge of the roof after Wiberg (CE), acetabular index (AI), neck-shaft angle (NS) and migration percentage (MP). The final evaluation of radiological results was carried out in accordance with Severin's classification. The clinical and radiological results obtained showed gradual deteriorations in comparison with the early postoperative results (dating from 12 months after surgery). In the final examination, in one patient a recurrent dislocation of the hip joint was diagnosed and subluxation was diagnosed in six patients (23%). Only the values of the CE angle went up (from -16 degrees in the early postoperative examination to 20 degrees in the final assessment), which we consider to be due to the change of sphericity of the head of femur. The remaining radiological parameters did not change significantly: AI from 22 degrees to 23 degrees, MP from 11% to 23%, NS from 133 degrees to 140 degrees. The surgical method presented is currently applied in a modified form, with a wider release within the soft tissues, more radical varusderotation osteotomy and greater shortening of the femur.
To compare the efficacy and safety of straight and J-shaped passive-fixation atrial leads we retrospectively analyzed the results of 100 consecutive implantations of atrial leads at one institution. There were seven cases of upgrades of VVIR to DDDR systems and in one case an active-fixation lead was chosen as a primary approach. These eight patients were excluded from the analysis. The final study group consisted of 92 cases (69 DDDR, 23 AAIR), 69 were J and 23 straight leads. The stimulation threshold, slew rate, impedance, P wave amplitude, and procedural time did not differ significantly between the two types of leads used. During the long-term follow-up of 6-53 months (30 +/- 11.9 months), replacements using active-fixation leads were required in two patients with straight leads and three patients with J leads (P = NS). In addition, one J lead showed signs of damage (impedance > 3,000 Ohm). Long-term follow-up values of the stimulation thresholds and P wave amplitudes did not differ between the groups (P = NS). Transesophageal echocardiography performed in 13 patients revealed a trend toward more distal placement of straight leads within the right atrial appendage. In conclusion, J-shaped leads do not seem to be superior to the straight leads for atrial implantations.
The results of femoral lengthening using the Italian modification of the Ilizarov are presented. Mean age of the patients was 14 years (ranging from 7 to 29). The most frequent etiology of limb shortening was femoral hypoplasia (7 patients) and sequelae of septic arthritis of the hip and/or the knee (6 patients). Indications for surgical treatment were limb shortening from 3 to 12 cm (mean 6.5 cm), along with axial deviation ranging from 10 degrees to 40 degrees in 6 patients. Mean follow-up time was 15 months (ranging from 6 to 35 months). The Ilizarov apparatus was based on two distal rings, stabilized by "K" wires, and proximally by a ring connected with an Italian femoral arch, stabilized by a Schanz screw. Planned lengthening (ranging from 3.5 cm to 12 cm) was achieved in all treated patients. The healing index ranged from 0.8 to 2.1 month/cm (mean 1.4). Problems, obstacles and complications were analyzed according to the Paley classification. In all 16 patients without primary knee stabilization, limited knee flexion ranging from 5 degrees to 90 degrees (mean 40 degrees) was noted during the distraction phase, which didn't improve significantly during the consolidation phase. Knee flexion improved to a mean 90 degrees after a 6 month follow-up. Bone regenerate defects (cysts, narrowing) were noted in 4 patients. Secondary knee stabilization was performed in 2 cases. In the first case because of knee pain and a severe limitation of knee motion. In the second, during a revision procedure because of distal femur angulation. Premature consolidation was noted in one patient and was treated by osteotomy. In one case axial deviation during the consolidation phase required osteotomy. In another case a fracture of the femur was treated by a plaster cast. In one case 1.5 years after the lengthening procedure subluxation of the hip was noted. Permanent knee flexion limitation to less than 90 degrees was noted in 6 patients. Femoral lengthening with the use of the Italian modification of the Ilizarov device give a high incidence of knee range of motion limitation, which can be decreased by preserving more than 30 degrees knee flexion during the distraction phase.
On the basis of available literature and his own experience the author presents some factors which influence the decision-making process in surgical treatment of congenital club foot and factors influencing the results of such treatment. The child's age at the time of operation, the type of the deformity after non-operative treatment, and the authors' indications for surgical treatment are considered.
INTRODUCTION: Vibroacoustic disease (VAD) is a heterogeneous and systemic entity, caused by long term (> or =10 yr) exposure to noise environments characterized by large pressure amplitude and low frequency (LPALF) (> or =90 dB SPL, < or = 500 Hz), and not explained by other possible etiologic agents. The goal of this study was to identify possible structural changes in hearts of men with suspected VAD. METHODS: A total of 485 men were divided into 3 noise groups: no noise exposure (< or =70 dB), n = 48 (Group I); moderate noise exposure, (>70dB and < 90 dB), n = 113 (Group II); and intense noise exposure (> or =90 dB), n = 324 (Group III). Echo-Doppler studies were performed (HP SONOS 1500) and recorded on coded videotapes. Three observers performed blinded evaluations of 26 echo-Doppler parameters. For the purpose of the present study only 12 morphological parameters were compared among the groups: thickening of the mitral, aortic, tricuspid, and pulmonary valves, pericardium and endocardium; mitral valve regurgitation, prolapse and ruptured chordae tendinae; and inflow velocities. Thickness and severity of the applicable parameters were scored in seven-grade scale (0,0.5,1, ...,3). RESULTS: All evaluated parameters were statistically significantly different in Group I vs. Group III, except flow velocity E. Comparison of Group I vs. Group II revealed statistically significant differences in mitral, aortic, tricuspid and pericardial thickening, with the strongest evidence for mitral and pericardial structures. CONCLUSIONS: This confirms the results of previous studies. Occupational exposure to noise environments characterized by LPALF noise causes structural changes in the heart. Mitral valve and pericardial thickening constitute the first signs of VAD.
The authors present most common complications after tumor related joint replacement. Twenty-six patients (9 females, 17 males) have been operated on (mean age 22.5 years). In 19 cases osteosarcoma was diagnosed, Ewing sarcoma in 4 and there were 3 cases of chondrosarcoma. Postoperatively, superficial skin necrosis occurred in 4 patients but healed in four weeks, full-thickness skin necrosis in 2 and in 2 cases wound infection resulted in septic loosening of endoprosthesis. The number of infections in our patients was low but caused delay of chemotherapy and need for revision of the infected joint.
Contrast echocardiography and harmonic imaging (HI) are promising new modalities applied in order to obtain improved visualisation of the left ventricle. Perflenapent (EchoGen, Abbott) is a new generation echocardiographic contrast agent that crosses the pulmonary capillary bed and produces long-term ventricle opacification. Our aim was to assess the left ventricle endocardial visualisation after perflenapent infusion and HI technique. We studied a pilot group of 10 patients (mean age 52.5 +/- 7.6, mean weight 76.9 +/- 10.1 kg, one female) with previously obtained sub-optimal non-contrast echocardiograms. Perflenapent was injected intravenously at dosis 0.05 ml/kg. Echocardiography was performed before perflenapent injection and during the time between injection and LV image disappearance. Images were assessed using four-point scale, 0 standing for the poorest and 3 for excellent visualisation. Perflenapent produced full chamber opacification in all pts. Contrast effect was observed for 550-15824 sec and myocardial enhancement was seen for 176-2116 sec after i.v. administration. After perflenapent administration, endocardial border was significantly better visible than before (1.9 +/- 0.57 vs. 2.9 +/- 0.31, p < 0.001). No hemodynamic effects were noted, as assessed by oxygen saturation, blood pleasure and heart rate. A mild, transient somnolence was seen in one pt. Perflenapent improved left ventricular function diagnostic capabilities, and provided enhanced visualisation of the myocardium.
Selected risk factors of solitary bone cyst recurrence after curretage and bone graft filling have been analyzed in this study. Seventy-four patients (42 males, 32 females) have been reviewed. The age of patients at the diagnosis ranged between 4 and 55 years (mean 12 years). During follow-up ranging from 1 year to 48 years (mean 18 years) 15 recurrences appeared. It has been found, that sex of the patient, localization and volume of the cyst, septa presence or absence within it have no statistically significant influence on the recurrence. Age below 10 years and the use of allogenic lyophilized bone grafts predispose for recurrence of solitary cyst of bone.
The new electromyographic test is based on fast Fourier transformation application for analysis of global electromyograms. Specifically designed Dynalog apparatus is described. Dynalog records EMG signal and transfers it to IBM-PC. One hundred thirty-eight global electromyograms were taken from 4 muscle groups (m.rectus femoris, m.deltoideus, mm. flexores antebrachii, mm. extensores antebrachii) in healthy individuals. Standard graphs of power distribution were obtained. Physiologically, at maximum voluntary contraction, power distribution spectrum of 4 muscles display characteristic, repeatable features. The frequency distribution range is 0-250 Hz. The records obtained show an ascending part (10-50 Hz), plateau (50-100 Hz) and mildly descending one at 150 Hz, subsequently to 250 Hz.
This study deals with mathematical assessment of physiologic and pathologic EMG frequency distribution by means of ranging. Material consisted of 161 pathologic EMG (63 myogenic cases, 98 neurogenic cases). In physiologic EMG power density distribution shows the highest values between 50 and 100 Hz, the lowest between 200 and 250 Hz. From 0 to 50 Hz power density increases, from 100 to 250 Hz-decreases. In patients with muscular diseases of different etiology the EMG power density spectrum is markedly different. The highest values appear more frequently between 0 and 50 Hz, sometimes also between 100 and 150 Hz. The frequency distribution allows mainly for assessing intensity of EMG pathology; is less useful for determination of its type.
Lower extremity lengthening by 14 to 16 cm (70-100%) was done in 10 children aged 8-10 years. Growth plate protection was secured by including it in distractor or performing arthrodiatasis. No physeal fusion was observed during 2-3 years follow-up. No valgus deformity of the tibia in fibular aplasia was noted either. The authors conclude that the management protects growth plate in extensive limb lengthening.
Contemporary views on etiology and treatment for solitary bone cyst are presented. Coehn theory of metaphyseal blood flow disturbances as the cause of solitary cyst formation has been emphasized. Minimally invasive treatment modalities have been honored as steroid or autogenous marrow injections into the cyst. Campannaci classification, the most versatile one, embracing various types of cyst remodeling after treatment has been introduced in Polish literature for the first time.
A series of 24 patients treated for chondrosarcoma between 1974 and 1991 is presented and compared with findings on patients treated from 1947 to 1973. Eleven patients were treated surgically alone, 7 were submitted to combined therapy (surgery and chemotherapy), in 6 cases palliative treatment was used. The survival after surgery ranged from 6 months to 23 years. Eleven patients died within 1 year after operation. Four patients lived longer than 5 years. Early diagnosis and treatment were prerequisites for good result. Radical resection of the tumor combined with chemotherapy resulted in extending patient's life; amputation had no such effect.
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Results of treatment of 17 patients operated because of aneurysmal bone cyst have been assessed. Age at the onset of symptoms ranged from 4 to 39 years, 14 on an average. There were 6 aggressive and active cysts in this series according to the Campanacci classification. Treatment consisted of segmental resection of the bone in 5 patients, curettage of the lesion filing of the defect with autogenous bone in 11 cases. Recurrence of the cyst has been observed in 3 patients, only one of them had aggressive type of tumor.
The electroneurograms of the tibial and median nerve in children with arthrogryposis have been performed; excitability curves which characterizes the function of the nerves were recorded. Afferent conduction velocity in 30 examined nerves showed statistically significant slowing down. An amplitude of evoked potentials in the tibial and median nerves was decreased but the difference compared to the control group was not statistically significant. Histograms based on electroneurography indicate existence of two groups of results, that might reflect neurogenic and/or myogenic origin of arthrogryposis. Excitability curve has been moved upwards and to the right in one point only, characterizing the tibial nerve function; in 5 remaining points the differences with controls were not significant. All-over results indicate subclinical afferentation impairment within lower extremities in children with arthrogryposis.