Barbara Jasiewicz

Results of simple excision technique in the surgical treatment of symptomatic accessory navicular bones

INTRODUCTION Accessory navicular bones might cause not only cosmetic problems but also be a reason of discomfort and pain. In case of inefficient conservative treatment symptomatic accessory naviculars are treated surgically. AIM OF PAPER Presentation of results of simple excision of symptomatic accessory navicular. MATERIAL AND METHODS Material consists of 22 patients (34 feet), 17 women and 5 men, treated surgically between 1992 and 2006. Mean age at surgery was 14.1 years (9-22 years). Accessory navicular type I was present in 5 feet (14.7%), type II in 17 (50%) and type III-in 12 (35.3%). Main symptom was localized pain on the medial arch of the foot, in the height of navicular bone. Surgery consisted of simple accessory navicular excision and if needed partial resection of navicular bone. The mean follow-up period was 5.6 years (1-13 years). We analyzed: intensity of pain (VAS score system), daily and sport activity. Subjective results were analyzed using a questionnaire. RESULTS The questionnaire was returned from 21 patients: 9 patients had total pain relief, 11 considerable and one patient had persistent pain. Mean VAS results before surgery was 5.9 and 1.7 after surgery. Only one patient required analgesics occasionally. Complications were present in two patients (6.1%). All active patients returned to their sport activities. CONCLUSION Surgical treatment of symptomatic accessory navicular by simple excision technique gives satisfying results, surgery is minimally traumatic and risk of complications low.

Long-term results of lower limb lengthening by physeal distraction.

Of the many methods of limb elongation, lengthening by physeal distraction is among the newest. The goal of this study was to estimate the long-term results of femoral and tibial lengthening by epiphyseal distraction. The authors examined 40 patients who underwent 24 femoral and 16 tibial lengthenings. The average follow-up period was 9.6 years. An average of 4.6 cm of femoral lengthening and 4.7 cm of tibial lengthening was achieved. The femoral healing index was 38.1 days/cm and the tibial healing index was 35.7 days/cm. After lengthening the epiphyseal cartilage started to function in all patients, and premature growth cartilage fusion was not observed during follow-up. Complications occurred in eight patients during femoral lengthening and in four during tibial lengthening. The authors suggest that physeal distraction is a good method for moderate and simple limb lengthening. Particular care should be applied to knee joint function, especially during femoral lengthening.

Spine deformities in patients with Ehlers-Danlos syndrome, type IV - late results of surgical treatment

BackgroundSpinal deformities in Ehlers-Danlos syndrome are usually progressive and may require operative treatment. There is limited number of studies describing late results of surgery in this disease.MethodsThis is a retrospective study of the records of 11 patients with Ehlers-Danlos syndrome type IV, treated surgically between 1990 and 2007. All patients underwent surgical treatment for spinal deformity. Duration of operation, type of instrumentation, intraoperative blood loss, complications and number of additional surgeries were noted. Radiographic measurement was performed on standing AP and lateral radiographs acquired before surgery, just after and at final follow up.ResultsThe mean follow up period was 5.5 ± 2.9 years (range 1-10 years). The mean preoperative thoracic and lumbar curve were 109.5 ± 19.9° (range 83° - 142°) and 75.6 ± 26.7° (range 40° - 108°) respectively. Posterior spine fusion alone was performed on 6 patients and combined anterior and posterior fusion (one- or two stage) on 5 cases. Posterior segmental spinal instrumentation was applied with use of hooks, screws and wires. The mean postoperative thoracic and lumbar curve improved to 79.3 ± 16.1° (range 56° - 105°) and 58.5 ± 27.7° (range 10° - 95°) respectively, with a slight loss of correction during follow up. The average thoracic and lumbar correction was 26.4 ± 14.9% (range 5.3 - 50.4%) and 26.3 ± 21.2% (range 7.9 - 75%). Postoperatively, the mean kyphosis was 79.5 ± 40.3° (range 21° -170°), and lordosis was 50.8 ± 18.6° (range 20° -79°). Hyperkyphosis increased during follow up while lordosis remained stable. Mean Th12-L2 angle was -3.5 ±9.9° (range -19° - 15°) postoperatively and did not change significantly during follow up.ConclusionsHuge spinal deformities in patients with Ehlers-Danlos syndrome require complex and extensive surgery. There is a big risk of sagittal imbalance in this group.

Development of a method for the determination of titanium in tissue by graphite furnace atomic absorption spectrometry for clinical analysis

A method was developed for the determination of low titanium concentrations in soft tissue. It is based on the microwave-assisted acid digestion of the samples and quantification of the element by graphite furnace atomic absorption spectrometry (GFAAS). The heating program was optimized through pyrolysis and atomization curves. The optimal temperatures were 1300 °C and 2600 °C for pyrolysis and atomization, respectively. Three matrix modifiers in various combinations were investigated and a mixture of 20 μg NH4H2PO4 and 6 μg Mg(NO3)2 allowed the best sensitivity and signal profile to be obtained. Under optimum conditions, the detection and quantification limits were 0.82 μg L−1 (33.61 ng g−1 of tissue) and 2.50 μg L−1 (102.48 ng g−1 of tissue), respectively. The characteristic mass was 88 pg. The recovery of added titanium in tissue samples was from 77% to 117%. Titanium was detected in 9 clinical samples and 12 animal meat samples, and its content ranged from 0.11 to 0.80 μg g−1.

Effectiveness of Treatment of Idiopathic Scoliosis by SpineCor Dynamic Bracing with Special Physiotherapy Programme in SpineCor System.

BACKGROUND The SpineCor dynamic brace for the treatment of idiopathic scoliosis is designed to maintain the correct position of the spine and a new movement strategy for 20 hours per day. The SpineCor exercise system intensifies and complements the brace treatment. This study evaluated the effectiveness of a comprehensive treatment of idiopathic scoliosis involving the SpineCor system. MATERIAL AND METHODS The study assessed a group of 40 patients (38 girls and 2 boys) with idiopathic scoliosis treated with the SpineCor brace. The average age at beginning of treatment was 13.1 yrs (10-15). Minimum treatment time was 18 months. 28 participants met the SRS criteria. Angles of the curve before and after bracing based on imaging studies were measured at the beginning and end of the treatment, analyzed and compared. Rehabilitation focused on teaching active corrective movement throughout the brace treatment. A control group was formed of 33 patients, including 21 meeting the SRS criteria, who used the SpineCor dynamic brace but did not participate in the associated exercise programme. RESULTS Among patients from the exercise group who met the SRS criteria, 25% demonstrated reduced curve angles, 35.7% demonstrated curve progression and 39.3% showed stabilization (no change). Among patients meeting the SRS criteria from the control group, a decrease in curve angle was observed in 14.3% of the patients, curve progression in 57.1% and stabilization in 28.6%. CONCLUSIONS 1. The addition of a dedicated physiotherapy programme to SpineCor dynamic bracing improves the chances of obtaining a positive outcome. 2. It is necessary to further analyse the course of the comprehensive treatment, also with regard to other types of braces and kinesiotherapy programmes.

Comparison of Postoperative Period in Patients with Pectus Excavatum Treated with Nuss Technique and Ravitch Technique.

BACKGROUND Pectus excavatum (PE) is the most common defect of the chest wall. Surgery for PE can be performed with an open or endoscopic technique. The choice of the surgical approach influences the postoperative course. The aim of the paper is to analyze the postoperative period in two groups of patients treated for PE. Group 1 consisted of patients who underwent endoscopic surgery, and Group 2 was composed of patients who underwent open surgery. A secondary aim is to compare the surgical outcomes between the two groups. MATERIAL AND METHODS The study group consisted of 40 patients treated in a single centre that uses a uniform postoperative analgesic protocol. The duration of surgery, blood loss, duration of hospital stay, complications, pain intensity and consumption of opioid and non-opioid analgesics were analyzed. The mean duration of follow-up was 9 months (6 -25 months). RESULTS Age at surgery, weight and height did not differ between the groups. In Group 1 the duration of surgery and blood loss were lower than in Group 2. In Group 1 complications occurred in 25% of the patients. Pain intensity was higher in Group 1 (4.23 vs. 3.67), as was the consumption of strong opioids (0.52 mg/kg body weight vs. 0.25 mg/kg body weight). Subjective evaluation was satisfactory in 85% of the patients in Group 1 and 90% in Group 2. CONCLUSIONS 1. Both techniques led to a satisfactory outcome. 2. The duration of surgery and blood loss were higher in the open surgery group, but pain intensity and consumption of strong analgesics were higher among the patients treated with the endoscopic technique. 3. Preparation for surgery should involve planning appropriate analgesic treatment in the post-operative period.

The Bootstrap Approach to the Comparison of Two Methods Applied to the Evaluation of the Growth Index in the Analysis of the Digital X-ray Image of a Bone Regenerate

The bone elongation by Ilizarov method is the important way of treatment of physical disability. During the elongation is necessary to control the accumulation of a regenerate and indicate the moment when fixator should be removed. The control is performed by observing the X-ray images and evaluation of the Regenerate Development coefficient. The automated image analysis is used to ensure the objectivity and reproducibility of the measurement. The authors have developed a new method for evaluating coefficient reflecting the specific treatment regenerate parts of an image associated with intramedullary nail. To assess the equivalence of the method with respect to the current, the bootstrap method was applied to sample of 23 X ray images. The bootstrap method provided the simulated distribution of the difference between the index obtained from the new method and the index obtained from the previous one.

Cervical spine surgery in patients with diastrophic dysplasia: Case report with long-term follow-up.

Cervical kyphosis in diastrophic dysplasia (DTD) is a very dangerous deformity which may lead to compression of neural structures resulting in tetraplegia or even. Treatment of this deformity is usually surgical, but no long-term follow-up studies are presented in the literature. Authors present a case of two children with DTD who underwent anterior corpectomy due to severe cervical kyphosis. The kyphotic deformity was corrected and the normal spinal canal width was restored. The effects of the correction remained stable for respectively 6 and 10 years of the follow-up period. The unique follow-up confirms that this type of intervention leads to an effective and long lasting results. Significant cervical kyphosis in patients suffering from DTD may be treated surgically using anterior approach even in young children with a favorable and lasting results.

PVDF Sensors – Research on Foot Pressure Distribution in Dynamic Conditions

The paper presents a dynamic measurement method of the distribution of foot pressure exerted on the ground by a four-point shoe insole, developed by authors, which can be placed in any sport footwear. The value of pressure was measured on the heel, medial midfoot, metatarsal, and great toe by recording values of a generated voltage by sensors which were made of piezoelectric polymer PVDF film 110 µm thick with printed silver electrodes. As confirmed by scanning microscope studies, the foil applied in the sensors is semi-crystalline. The shoe measurement insert consists of two polyester films without piezoelectric properties between them, electroactive polymer sensors were placed. The films were glued together. To match the measuring circuit to the sensors used, two circuits were tested, a voltage measuring circuit with an input resistance of above 1012 Ω (open circuit), and a charge measuring circuit (shorted circuit). The charge measuring circuits with the RC high-pass filter, which attenuates the slow-changing pyroelectric signal was selected as it ensures the desired measurement accuracy. As presented in the paper, as PVDF sensors are very sensitive to any mechanical deformation, it is important to properly design the shoe insole to ensure its correct use during pressure distribution measurements. The measuring system developed by the authors, allows testing of foot pathology for any length of time in a dynamic way.

Application of a system for measuring foot plantar pressure for evaluation of human mobility

The paper presents evaluation of human mobility by gait analysis, carried out in natural conditions (outside laboratory). Foot plantar pressure is measured using a shoe insole with 8 sensors placed in different anatomical zones of the foot, and placed inside a sports footwear. Polarized PVDF foil is used as a sensor material. A wireless transmission system is used to transmit voltage values to the computer. Due to linear relationship between force and transducer voltage, energy released during walking in arbitrary units can be calculated as integral of the square of transducer voltage over time. Gait measurements have been done over the next few days on healthy person during normal walking and slow walking. Performed measurements allow determination of walking speed (number of steps per second), gait rhythm and manner of walking (applying force to inside versus outside part of the sole). It is found that switching from normal to slow walk increases gait energy by 25% while the pressure distribution across the anatomical regions of the foot remains unchanged. The results will be used for developing a programme for evaluation of patients with cardiac failure and future integration of actimetry with pulse and spirometry measurements.