Biomedical subjects

J Poul

Publications and source records attributed to J Poul.

At least 19 recordsLinked to original sources

PubMed2006

[Treatment of congenital pseudarthrosis of tibia by vascularized fibular graft].

PURPOSE OF THE STUDY: The aim of the study was to evaluate the results in a group of patients with congenital pseudarthrosis of the tibia treated by transfer of a vascularized fibular graft from the contralateral extremity. MATERIAL: The group included three boys and two girls aged 2 to 8 years at the time of surgery. In two patients, the vascularized graft transfer was preceded by other operations. All patients but one had Crawford type IV pseudarthrosis. The signs of peripheral neurofibromatosis were found in four of the five patients. METHODS: The operation was carried out by two surgical teams, i. e., orthopedic and microsurgery (plastic surgery) specialists. Deep dissection of the pseudarthrosis was performed down to healthy, well vascularized tissue; a vascularized pedicle bone graft was harvested from the contralateral fibula. The graft was inserted and anchored intramedullarily in both tibial fragments, and stability was provided with a K-wire introduced through the calcaneus. Subsequently, the vascular pedicle of the fibular graft was joined to the surrounding vessels (anterior tibial artery and anterior tibial vein). The extremity was immobilized in plaster cast and later a KAFO brace was applied. RESULTS: Graft union partially failed in the proximal end of the graft due to bone resorption of both the graft and the proximal tibial fragment in two patients. This was successfully treated by additional spongioplasty. In all patients bony union was achieved at an average time of 9.8 months (range, 6 to 21 months). An increase by more than 100 % in the diameter of the transplanted fibula was recorded in four patients. The increase, which was of course related to follow-up time, was a clear proof of primary graft vascularization. DISCUSSION: The use of vascularized fibular graft harvested from the contralateral extremity showed high effectiveness in comparison with other methods. This was in agreement with the relevant literature reports. CONCLUSIONS: This method can be used regardless of patients' age and our experience showed that, even in small children, union can be achieved and can thus allow for early weight-bearing and prevention of crus atrophy.

Bone Transplantation↗

PubMed2006

[Remodelling ability of the distal radius in fracture healing in childhood].

INTRODUCTION: Distal forearm fractures are among the commonest skeletal injuries in childhood. The aim of this work is to analyze factors determining remodelling abilities of the distal radial metaphysis in dislocated fractures, considering a requirement for eventual non-operative repositioning. MATERIAL AND METHODOLOGY: The primary patient group included a group of patients treated in 2004 for distal radial metaphysis fractures, left to heal in a dislocated position. The angle of dislocation ranged from 8 to 30 degrees. All patients underwent a follow up x-ray examination 2, or more, years later and a clinical examination of the wrist joint range of motion. The extent of remodellation was studied, considering duration of the healing process, patient's age and the fracture line distance from the growth plate. RESULTS: The results show that in the majority of the patients included in the study, complete remodellation of the radius nearly to its anatomical position (86%) occurred. The results were significantly better in the patient group aged 0-12 years. Furthermore, significantly less residual dislocations were recorded within 20 mm from the growth plate. Restriction of the wrist joint range of motion resulting from residual dislocation was not recorded. CONCLUSION: Based on the results, conservative treatment of the condition, especially in cases of multiple injuries or of a polytrauma, is recommended. Also, in cases of deterioration of the positioning or of redislocation after repositioning, repositioning need not be repeated in patients below 12 year of age.

Adolescent↗

PubMed2005

[Video-assisted tenotomy of the triceps muscle of the calf in cerebral palsy patients].

PURPOSE OF THE STUDY: The aim of the study was to demonstrate the outcomes of video-assisted tenotomy of the gastrocnemius and soleus muscles in children with the spastic form of cerebral palsy. MATERIAL: In the period from September 2003 to March 2004, 18 lower extremities in 14 patients were operated on.A set for endoscopic plastic surgery with a 4-mm trocar was used. Aponeurotomy was carried out with a scalpel no. 11 or arthroscopic scissors. The treated limb was immobilized in plaster cast for 6 weeks. METHODS The inclusion criteria were: an equinus gait free from a valgus or a varus deviation, preferably unilateral, and the age range between 4 and 10 years. The patients were examined before surgery and followed up at 3-month intervals. RESULTS: In 16 out of 18 treated extremities, simple aponeurotomy of the gastrocnemius and soleus muscles was sufficient to achieve 20 degrees dorsiflexion. In two cases it was necessary to complete the procedure at the same stage by video-assisted sliding double-point tenotomy of the Achilles tendon. The short-term follow-up did not reveal complications such as failure of wound healing or neurological or vascular disturbance. DISCUSSION: The international literature data show that this method has largely been developed on cadavers. Much attention has been given to potential injury to the sural nerve. However, the ultimate goal of this operation, i. e., sufficient correction, should be regarded as a much more important factor. In older children, simple aponeurotomy may not achieve this objective and therefore the authors developed a procedure combining video-assisted aponeurotomy with sliding double-point tenotomy of the Achilles tendon. CONCLUSIONS: Video-assisted tenotomy of the gastrocnemius and soleus muscles proved a fully effective method in our group evaluated at short-term follow-up.

Cerebral Palsy↗

PubMed2005

[Massive spongioplasty and external fixation in the posttraumatic pseudoarthrosis management--a case review].

The authors of this case review present three cases of posttraumatic pseudoarthroses as complications of open fractures of the forearm and the course of their treatment. External fixation with the Ilizar external fixation apparatus and bridging spongioplasty was applied in all patients. In the first presented case, the external fixation and spongioplasty was required after resection of the atrophic posttraumatic pseudoarthrosis. In the remaining two cases, furthermore, transposition of the distal fragment of the radius using distraction in order to correct its position against the distal part of the ulna, was required. The pseudoarthroses healed in all three subjects. The case review highlights the key significance of the external fixation method and the massive spongioplasty.

Adolescent↗

PubMed2004

[Bone surgery for unstable hips in patients with cerebral palsy].

PURPOSE OF THE STUDY: The aim of this retrospective study was to compare the efficacy of femoral osteotomy alone with that of osteotomy combined with an acetabular procedure in patients with unstable hips due to spastic cerebral palsy. MATERIAL: Sixty-one hip joints in 50 patients who had shown distinct subluxation or dislocation of the joint were operated on. Eleven patients underwent bilateral surgery. Before bone surgery, soft-tissue release involving both the flexors and adductors was performed on 19 hips. Femoral osteotomy alone was performed on 29 hip joints and combined femoral and pelvic osteotomy was carried out on 32 joints.Twelve resections of the proximal femur in seven patients were evaluated as a separate group. All treated hip joints were assessed by clinical and radiographic examination at a follow-up of more than 5 years. METHODS: The skiagraphs taken in a strictly neutral position of the lower limbs before surgery and at the final examination were evaluated on the basis of Reimers's migration index and Wiberg's centre-edge angle. The locomotor abilities of each child were categorized according to the Vojta scoring system for locomotor development. The range of motion in the treated hip joint was assessed using the standard S. F. T. R. method. The results obtained were statistically analyzed by the Kruskal- Wallis, one-way ANOVA test. RESULTS: A comparison of the results of femoral osteotomy alone with those of combined femoral and pelvic osteotomy showed that the post-operative values of the migration index and centre-edge angle, as compared with the pre-operative ones, were statistically higher (p<0.05) in the latter. In a long-term perspective, the surgery had no adverse effects on a natural development of locomotor abilities of the child. The children had higher scores by the modified Vojta rating system. There was no change in the range of motion in the treated hip joints after the operation. DISCUSSION: In 28, out of the 32 joints treated by combined femoral and pelvic osteotomy, Salter osteotomy was performed and it showed a high efficacy in providing hip joint stability. The main emphasis during surgery was placed on the maximum acetabular rotation laterally. Femoral osteotomy alone was less effective in providing hip joint stability; in addition, in order to achieve this, tilting of the proximal fragment to a varus position was generally higher than in combined operations. In three patients this treatment resulted in fixed adduction of the hip joint with negative consequences for movement. CONCLUSIONS: In the treatment of unstable hip joints a combination of varus derotation femoral osteotomy and pelvic osteotomy provides better containment of the joint than femoral osteotomy alone.

Acetabulum↗

PubMed2004

[Options for correction of post-traumatic length discrepancies in forearm bones in children (case reports)].

Correction of radius length after a premature complete or partial closure of the distal epiphyseal plate is important for both the correction of radial deviation of the hand and the restoration of normal function of the radiocarpal articulation. This study comprised four patients. Two children with complete closure of the epiphyseal plate of the distal radius underwent callotaxis. One patient was treated for atrophic pseudoarthrosis of the distal radial metaphysis by external fixation and subsequent spongioplasty. One patient with partial closure of the epiphyseal plate was treated by physeal distraction. In each patient an Ilizarov's external fixator was applied. The full correction of radius length was achieved in all cases. No complications were recorded with the exception of tissue irritation around Kirchner's wires, which occurred mainly on the volar side. In the therapy of injuries suffered during adolescent growth acceleration, it is necessary to perform a certain overdistraction of the radius. An alternative method includes epiphyseodesis of the distal ulna. Key words: post-traumatic closure of the epiphyseal plate, callotaxis, physeal distraction, chondrodiatasis.

Adolescent↗

PubMed2003

[Periosteal tethering of growth plates in long bones (focal fibrocartilaginous dysplasia)].

PURPOSE OF THE STUDY: Another three cases of periosteal tethers (focal fibrocartilaginous dysplasia) are reported. Until now only 54 children affected by this entity were described. Analysis of these three cases concerning clinical appearance, x-ray deformity, preoperative and histologic findings and the end-results of the own method of surgical treatment was undertaken to categorise the proper diagnosis. MATERIAL: The studied group involved distal posteromedial femoral lesion (Boy aged 11 months, Epiphysis-diaphysis angle 68 degrees, femoro-tibial angle 27 degrees). Another case with proximal tibial lesion on the lateral side (Boy aged 18 months, Epiphysis-diaphysis angle 75 degrees, femoro-tibial angle 18 degrees). Third case with proximal tibial lesion, localised typically medially (Boy aged 17 months, Epiphysis-diaphysis angle 70 degrees, femoro-tibial angle 19 degrees). METHODS: All three cases were routinely followed for short time, before surgical correction was performed. AP and lateral x-rays were undertaken. Surgical correction involved curretage of the lesion and a half-circumferential excision of the periost between the lesion and the physis. Short-term immobilisation followed. In no case an osteotomy was needful. RESULTS: Limited surgical approach consisting of curretage and periost excision resulted in slow but full correction of the long bone angulation. In the distal femoral lesion the normal value of limb axis was achieved in 9 years, in proximal and lateral tibial lesion in 7 years and in proximal and medial tibial lesion in 3 years. Persisting shortening of the limb length was found only in femoral lesion involving 10 millimetres. Histologic findings comprised areas of dense fibrous tissue, of fibrocartilage and of sclerotic bone. Bacterial cultivation was negative. DISCUSSION: It seems, that there is almost no difference between clinical, x-ray and preoperative findings of periosteal tethers and focal fibrocartilaginous dysplasia. A real fibrous band between the cortical lesion and the physis was not found in this study, however the periost was roughened and adhered firmly to the bone. Limited surgical exposure consisting of curretage and half-circumferential excision of periost quaranteed in all three cases full correction of the former deformity. CONCLUSION: Osteotomy is not an absolutely necessary surgical solution in these cases.

Child↗

PubMed2003

[Causes of development of genu recurvatum after surgical treatment in spastic forms of childhood cerebral palsy].

PURPOSE OF THE STUDY: To evaluate the contribution of different surgical techniques of lengthening of distal hamstrings on the development of hyperextension deformity of the knee in spastics. MATERIAL: Totally 51 patients of age 7.6 + 3.7 years at operation. Follow-up after surgical release for 4-10 years. Basically two surgical techniques were used: 1. Simple division of gracilis and semitendinosus, fractional lengthening of semimembranosus and biceps femoris. 2. Gracilis and semitendinosus were anchored after its transverse division to fractionally lengthened semimembranosus. METHODS: Pre-operative and post-operative Bleck popliteal angles were estimated. Hyperextension was tested in lying and standing positions. RESULTS: Type of surgery (1 or 2) did not influence the development of hyperextension deformity of the knee (tested by Fisher exact test). Nevertheless the relation between type of surgery (1 or 2) and the stratified value of Bleck popliteal angle was statistically significant. In the subgroup 2, in which the superficial tendons were anchored to semimebraneous, the occurrence of values of Bleck angle less than 20 degrees, was lower than in the subgroup 1. DISCUSSION: It seems, that the type of described two different surgical techniques is not so much decisive for development of hyperextension deformity. CONCLUSION: Authors surmise, that principal role play stronger deep knee flexors (semimembranosus and biceps femoris). Its fractional lengthening must be very careful.

Cerebral Palsy↗

PubMed2003

[Percutaneous aponeurotomy of the triceps surae muscle in cerebral palsy in children].

PURPOSE OF THE STUDY: To assess the short-term results of percutaneous aponeurotomy of gastrocnemius including the possible complications and effects of the treatment. MATERIAL: Totally 88 procedures were performed in 61 patients in the period 1998-2001. Re-examination in 2002 involved 44 patients with 66 procedures. METHODS: The procedure was done from one-point incision. Six weeks immobilisation followed. Re-examination concerned the shape of the calf, the testing for palpable defect, US examination of calf muscles and aponeurosis, neurological and vascular examination. RESULTS: Recurrence of mild degree of equinus deformity was found in 3 out from 66 procedures. No neurological or vascular complications were registered. DISCUSSION: Rate of recurrence in this study is comparable with the figures after open aponeurotomy. CONCLUSION: Operation is reserved for skilled surgeon, however in short future, most of operations on spastics will be done like video-assisted procedures.

Cerebral Palsy↗

PubMed2001

[Prevention of development of hip joint instability in patients with the spastic form of juvenile cerebral palsy].

PURPOSE OF THE STUDY: How effective are the hip adductors and flexors tenotomies for the correction of unstable hip joint in cerebral palsy? MATERIAL: The study included 45 children with contractures of the hip adductors and flexors and hip subluxations due to spastic cerebral palsy. Thirty three of them were boys and 12 were girls. Their ages ranged from 2 to 13 years. Preoperative and postoperative roentgenograms of 82 hip joints were investigated. METHODS: Open tenotomies of m. adductor longus and brevis, m. gracilis, m. rectus femoris and m. psoas major. The immobilisation by POP casts lasted for 6 weeks. Abduction and extension bracing followed the plaster removal in all children. The hip joints were radiographed in neutral rotation both before and at least 6 months after the operation. Reimers migration percentage (MP) and Wiberg angle (CE angle) known as the parameters of hip instability were assessed. The obtained data were statistically analysed. RESULTS: The preoperative MP was below 25% in 25 hips, between 25 and 39% in 33 hips, between 40 and 59% in 14, and over 59% in 10 hips. The analysis of postoperative roentgenograms showed the following MP distribution: 56 less than 25%, 23 between 25 and 39%, and 3 greater than 40%. No postoperative MP was higher than 49%. 54% formerly subluxated hips achieved normal MP. The difference between preoperative and postoperative MP was statistically significant (P < 0.001). Before the tenotomies 24 hips were normal with CE angle over 20 degrees. It was between 20 degrees and 11 degrees in 28 cases and between 10 degrees and 1 degree in 17 cases. The preoperative CE angle was negative in 13 cases. Postoperatively CE angle was higher than 20 degrees in 53 hips. It was between 20 degrees and 11 degrees in 22 cases and between 10 degrees and 1 degree in 7 cases. The minimum CE angle after soft-tissue release was 4 degrees. The difference between preoperative and postoperative CE angles was statistically significant (P < 0.001). MP improved in 93% and CE angles in 96% of cases. DISCUSSION: Classical tenotomies of the spastic hip adductors used to be recommended in prevention of the hip subluxation in cerebral palsy patients. MP improved in 70% of cases in the Reimers' study (1980) based on selective adductors tenotomies. If the soft tissue release was unsuccessful bony operation was indicated. Kalen and Black claimed in 1985 that if psoas tenotomy was performed in addition to adductors tenotomies MP improvement was attained in 80-100% of cases. CONCLUSION: Adductors and flexors tenotomies can correct the spastic hip joint instability fully and permanently if the operation is performed prior to bony changes of the hip. The operation being followed by appropriate immobilisation and physiotherapy increases the percentage of good results.

Adolescent↗

PubMed2001

Triple osteotomy of the pelvis in children and adolescents.

PURPOSE OF THE STUDY: To assess the results of Steel triple osteotomy on Developmental hip displacement (DDH) and Legg-Calvé-Perthes Disease (LCPD) cases utilising objective criteria based on measurements. All measurements were done by a co-author in a blind way. What concerns DDH, triple osteotomy was used in all cases in which authors felt to obtain a profit for a patient, so that hips with non-spherical head were operated on, too. On the other hand, as far as the experience with Steel osteotomy in LCPD is very limited, authors used this method presuming to obtain similar effect like with Salter osteotomy in younger patients. MATERIAL: 41 Steel osteotomies carried out in 29 cases of developmental dislocation of the hip (DDH), (age ranging 14-23 years) and in 12 cases of Legg-Calvé-Perthes disease (LCPD), (9-12 years of age) have been analysed. The follow-up duration was 4-12 years. METHODS: Differently to the postulations of Dr. Steel, the inaugurator of triple osteotomy for DDH cases, indications in this study were also extended to aspherical congruencies and even incongruencies in DDH. Besides measuring CE, Sharp angles and Reimer's index, there was used subjectively descriptive classification of both initial conditions and results. The reached medialization and caudalization of the femoral head to Shenton line played an important role at the evaluating classification of the results. All obtained data were processed by the statistical methods to ascertain the influence of the operation. The same measuring methods were used for assessment of LCPD cases. RESULTS: Fisher's exact test has shown the dependence of the results in DDH on the preoperative finding, reflecting the fact, that the triple osteotomy did not improve substantially the parameters of the more distorted hip joints. With the greater degree of joint deformity, the chance to obtain postoperative correction was less. Complete correction in all the DDH group was obtained in 20, partial correction in 7 cases and failure was found in 2 cases. Fisher exact test in LCPD demonstrated that results are not statistically dependent on the initial state. Complete correction in LCPD group was obtained in 10, partial correction in 1 and failure in 1 case. DISCUSSION: It seems that the indication of Steel triple osteotomy in DDH must be highly well-considered concerning especially the containment of aspherical femoral head. Indication should be based on careful pre-operative planning using dynamic contrast arthrography helping to find the best position of femoral head through the additional femoral osteotomy. Hitherto rare application of Steel osteotomy for LCPD everywhere seems to be little irrespective of the fact that this operation can secure the containment of even deformed femoral head with the perspective of its subsequent remodelling as showed this study. CONCLUSION: The historical postulate of inaugurator of triple osteotomy, concerning the sphericity of the femoral head as a condition sine qua non, seems to be broken especially in Legg-Calvé-Perthes disease. Even sattle deformity of femoral head can be corrected. What concerns the DDH the greater degree of joint deformity, especially aspherical incongruency brings about the risk of failure of surgical procedure. Nevertheless, in this study five out from seven cases of that degree of distortion obtained at least partial correction.

Adolescent↗

PubMed2001

[Results of lengthening 20 humeri].

PURPOSE OF THE STUDY: The aim of the retrospective study was to evaluate the results of 20 performed lengthenings of the humerus in children and adolescents. MATERIAL: Assessment involved totally 20 lengthening procedures having been done in 18 patients, twice as a repeated procedure, in the period 1983-1999. The indication was shortening of humerus approaching at least the amount of 50 millimeters. Proportion of boys and girls was 7/13. The shortening arouse on the base of pyogenic infection in 12, post-traumatically in 3, congenitally in 2 and in one case it was caused by a bone cyst expansion. Mean value of shortening was 83 millimeters. Mean value of age was 12 years, ranging from 7 till 16 years. METHODS: Lengthening procedure was performed by the use of different types of external fixation. In most cases Wagner unilateral fixator was used (13 cases). The choice of external fixator was based more on its availability determined by economical reasons. Contrary to Wagner and Orthofix, Ilizarov fixator did not need the common replacement of different sizes of apparatus during lengthening. Osteotomy was routinely performed at the point between the distal and middle thirds of the length of humerus, approach was always associated with visualisation of the radial nerve. RESULTS: Serial x-rays were consecutively studied to specify the mean value of lengthening--71 millimeters, the mean value of distraction phase--91 days, the mean value of total period of fixation--197 days and the mean value of period determined at its end by the full re-canalisation of the lengthening zone--355 days. Mean value of bone lengthening index was calculated on 13.2 days/1 centimeter, mean value of bone healing index on 28.6 days/1 centimeter, and a modified bone healing index based on full recanalisation of the lengthening zone with a mean value of 44.5 days/1 centimeter. In no one case an additional bone grafting or plate osteosynthesis was necessary. Complications involved 3 cases of transient radial nerve palsy, which spontaneously resolved. DISCUSSION: As other reports of humerus lengthening respecting "callotasis method", this study showed almost uneventful distraction and healing This cohort involves a big sample of lengthenings resembling in its size the cohort of Cattaneo et al., the world's biggest group. CONCLUSIONS: It was proved, that the humerus lengthening is a safe method solving successfully the cosmetic problem of length deficiency. It seems, that presumably the keeping up the principle of "callotasis" brings about uneventful treatment programme.

Adolescent↗

PubMed2001

[Rotational acetabular osteotomy in the treatment of Legg-Calve-Perthes disease].

PURPOSE OF THE STUDY: The material of prospective study involving 57 surgically treated hips in 55 patients suffering with a severe form of Legg-Calvé-Perthes disease (LCPD) was analysed by the use of statistical methods to depict the influence of age, of sex, of the amount of head involvement on the outcomes of surgical treatment by rotational acetabular osteotomy (Salter or Steel osteotomy from 9 years of age). MATERIAL: During the period 1990-2000 rotational acetabular osteotomy for Legg-Calvé-Perthes disease was performed totally in 124 patients. Excluded were cases, in which the operation was done for residual subluxation as a definitive outcome of former LCPD, cases which did not return for controls, cases with not yet completed consolidation after surgery and cases operated by me abroad. Totally were analysed stastistical sheets from 57 rotational acetabular osteotomies, including basis dates from medical history, clinical and x-ray examinations. Special concern was given to the evaluation of remodellation of the affected femoral head chronologically. METHODS: All patients were operated by the group of three senior orthopaedic surgeons. Indication for surgery was based on the evidence of the progressive collapse of the femoral head issuing in the lateral and anterior head extrusion. As the Mose as well as Stulberg classification are showing inter-rater discrepancies, authors measured as well head-neck index, epiphyseal index and acetabulum-head index to eliminate subjectives errors. RESULTS: Age at operation and sex did not affect the results expressed in epiphyseal quotient and acetabulum-head index. With the increasing age the head-neck index dropped down depicting the progressive shortening of the femoral neck the older kids. The periods from the operation till the consolidation of the lateral pillar of the femoral head were longer in younger than in older children. Although the evaluation of results in Mose classification showed poorer results generally and also specifically in relation to the increasing age, distribution of results in Stulberg classification showed excellent and fair results in almost 90% of all treated patients. DISCUSSION: Prospective study based on the use of rotational osteotomy, avoiding the routine combination with varisation of the proximal femur in older kids using in them Steel triple osteotomy, showed promising results especially in Stulberg classification. Contrary to Salter and others prerequisiting for the indication of operation only slight deformity of the affected femoral head, many of the enrolled cases appeared with the remarkable deformity of the femoral head before the operation. Rotational acetabular osteotomy showed its potential to involve the enlarged head and follow-up depicted its subsequent slow remodellation. CONCLUSIONS: Submitted study was prepared to be matched nextly with the conservative group, which will be published in another publication. Internal analysis of the presented cohort disclosed that presented surgical treatment (Salter or Steel osteotomy respectively) assured, that irrespective of higher age, the important parameters like epiphyseal quotient and acetabulum-head index did not become worse than in younger groups. Even in the group over 9 years of age, 87.5% were categorised like excellent and fair results in Stulberg classification.

Acetabulum↗

PubMed1999

Comparative in vitro and in vivo assessment of genotoxic effects of etoposide and chlorothalonil by the comet assay.

The alkaline single cell gel electrophoresis (comet) assay was used to assess in vitro and in vivo genotoxicity of etoposide, a topoisomerase II inhibitor known to induce DNA strand breaks, and chlorothalonil, a fungicide widely used in agriculture. For in vivo studies, rats were sacrificed at various times after treatment and the induction of DNA strand breaks was assessed in whole blood, bone marrow, thymus, liver, kidney cortex and in the distal part of the intestine. One hour after injection, etoposide induced DNA damage in all organs studied except kidney, especially in bone marrow, thymus (presence of HDC) and whole blood. As observed during in vitro comet assay on Chinese hamster ovary (CHO) cells, dose- and time-dependent DNA effects occurred in vivo with a complete disappearance of damage 24 h after administration. Even though apoptotic cells were detected in vitro 48 h after cell exposure to etoposide, such a result was not found in vivo. After chlorothalonil treatment, no DNA strand breaks were observed in rat organs whereas a clear dose-related DNA damage was observed in vitro. The discrepancy between in vivo and in vitro models could be explained by metabolic and mechanistic reasons. Our results show that the in vivo comet assay is able to detect the target organs of etoposide and suggest that chlorothalonil is devoid of appreciable in vivo genotoxic activity under the protocol used.

Animals↗

PubMed1998

Ultrasound examination of neonate's hip joints.

In a mass screening project, 872 neonates were examined clinically and by ultrasound. Hip joint stability was assessed in the ultrasound stress test showing a normal or physiologic instability, in the range of 0 to 2 mm. Along with the dynamic examination, a modified Graf's method was used. All obtained sonograms were submitted to careful assessment by one of authors, including regular measurement of alpha and beta angles. This relatively small group in the low-risk population served as a model of normality. White newborns compared with an black Caribbean group did not show the presence of apparent primary acetabular dysplasia. Both methods--dynamic ultrasound test and Graf's scanning--seemed to us to be valuable.

Hip Dislocation, Congenital↗

PubMed1998

Selective treatment program for developmental dysplasia of the hip in an epidemiologic prospective study.

Over 1 year of ultrasound (US) mass screening, 4,568 newborns were examined consecutively at age 3-4 weeks using both clinical and ultrasonographic examination methods. The US examination involved both the static and dynamic scanning. In total, 25 babies were treated early (5.5 per 1,000), and 6 babies were given late treatment for postnatally developing acetabular dysplasia (1.3 per 1,000). Early treatment was instituted only for hips remarkably distorted anatomically, as could be seen from their shape on the static scan, and for those that were sonographically unstable with an apparent stress displacement. Clinical examination at age 3-4 weeks failed in more than half of all sonographically abnormal cases. In one case, the postnatal development of the hip joint was associated with the worsening of its formation and a developing subluxation despite its primary normal characteristics.

Czech Republic↗

PubMed1993

Local action transcutaneous flurbiprofen in the treatment of soft tissue rheumatism.

The objective of the present study was to establish the efficacy and tolerability of local action transcutaneous flurbiprofen (flurbiprofen LAT) in the treatment of soft tissue lesions. A randomized, double-blind, parallel-group placebo-controlled study was carried out in two hospital outpatient rheumatology clinics. One hundred and four patients aged 18-75 yr were randomized to receive a non-woven polyester-backed patch supporting a formulation containing 40 mg flurbiprofen 12-hourly over 14 days; or a non-medicated (but otherwise identical) control. Statistically significant differences in favour of the active preparation were seen at both days 7 (P = 0.02) and 14 (P = 0.009) for the investigator's overall opinion of severity of the condition, and at day 7 for the investigator's assessment of pain severity (P = 0.04 intention-to-treat; P = 0.052 N.S. eligible data). The need for further treatment in the form of steroid injections after the trial was greater in the controls (29/44, 66%) than in the flurbiprofen LAT group (17/46, 37%) (chi 2 = 7.54 on 1 d.o.f., P = 0.006). Plasma flurbiprofen levels in 11 patients ranged from 13.4 to 338.7 ng/ml (mean 116; median 57.9). Eight out of 53 (15%) patients receiving flurbiprofen LAT reported a total of 10 adverse events, compared with three out of 51 (6%) reporting seven events among controls. Patients found the patch convenient and soothing. We conclude that flurbiprofen LAT is an effective and acceptable treatment for soft tissue lesions, and should be considered as an alternative therapy to local steroid injection.

Administration, Cutaneous↗

PubMed1993

[Cooperation between the pediatrician and orthopedist in the diagnosis of congenital hip dislocation].

The author summarizes the principles of clinical diagnosis, referring to experience assembled in an investigation comprising more than 35,000 neonates during past years. The submitted pattern could be a practical instruction for examination of the hip joints by paediatricians--neonatologists. The author emphasizes the fact that the diagnosis of complete dislocation unless irreponible is very easy, and being a clinically very obvious defect, it should not be missed. In other countries the trend predominates to ensure examination of the hip joints of neonates by paediatricians-neonatologists for whom this examination is a matter of routine. The author outline possibilities of ultrasonographic examination, static as well as dynamic. In large towns it proved useful to establish an ultrasonographic examination room where some 4000 infants aged 2-3 weeks are examined. The hitherto used classification of ultrasonic examination is not quite reliable in view of "over-diagnosis" and thus to unnecessary therapy which can lead--as any abduction therapy--to complications such as avascular necrosis. Paediatricians-neonatologists should master the clinical problem and be aware of the responsibility for early clinical diagnosis to enable orthopaedists to specify indication for early treatment based on ultrasonographic examination.

Hip Dislocation, Congenital↗