Rheumatoid arthritis (RA) is chronic, autoimmune joint inflammation characterized by irreversible joint destruction. Besides increased resorption, destruction is a result of decreased bone formation, ...due to suppressed differentiation and function of the mesenchymal lineage-derived osteoblasts in inflammatory milieu. In this study, we analyzed the cellular composition of synovial tissue from 11 RA and 10 control patients harvested during planned surgeries in order to characterize resident synovial progenitor populations. Synovial cells were released by collagenase, and labeled for flow cytometry by two antibody panels: 1. CD3-FITC, CD14-PE, 7-AAD, CD11b-PECy7, CD235a-APC, CD19-APCeF780; and 2. 7-AAD, CD105-PECy7, CD45/CD31/CD235a-APC, and CD200-APCeF780. The proportions of lymphocytes (CD3+, CD19+) and myeloid (CD11b+, CD14+) cells were higher in synovial tissue from the patients with RA than in the controls. Among non-hematopoietic (CD45−CD31−CD235a−) cells, there was a decrease in the proportion of CD200+CD105− and increase in the proportion of CD200−CD105+ cells in synovial tissue from the patients with RA in comparison to the control patients. The proportions of both populations were associated with inflammatory activity and could discriminate between the RA and the controls.
Giant cell tumour (GCT) is a rare, benign tumour, but it has a locally aggressive nature and a high rate of recurrence. A wide en-bloc resection of the distal part of the ulna, with or without ...stabilisation of the ulnar stump, is the recommended treatment option. Functional results after that kind of surgery are mostly satisfying but, in some cases, it can result in wrist instability, causing pain and weakness of grip strength. That is why when it comes to young people, with high functional demands, we prefer reconstruction of distal ulna and distal radioulnar joint after an en-bloc resection of the distal ulna. The distal ulna is reconstructed with an autologous free fibular graft and the distal radioulnar joint is stabilised with an autologous palmaris longus tendon graft. We present our operative technique and good functional results of three young patients treated with this procedure. Our results confirm the hypothesis that the reconstruction of the distal ulna and the distal radioulnar joint leads to a satisfactory functional result in young and active patients with higher functional demands.
Introduction:
The majority of acetabular revisions can be performed with an uncemented, porous acetabular component with or without bone grafting. These are contained acetabular defects, with an ...intact acetabular rim (Paprosky type I and II). As defects of the medial wall of the acetabulum are a challenge situation revision surgery, we performed this biomechanical study on a pig pelvis model with contained acetabular defects to determine the size of medial wall defect at which the acetabular cup will have sufficient primary stability.
Materials and methods:
In 24 pig pelvis models, different diameter of medial wall defects were created, followed by acetabular component placement. The acetabulum externally loaded, and the force at a level in which the acetabular component remains stable for each diameter of defect, or at which point the acetabular cup moves into the pelvis for >2 mm.
Results:
In the models with acetabular medial wall defects of 10 and 20 mm, 2 mm acetabular displacement occurred under a force between 1000 and 1500 N. In those with a medial wall defect of 25 mm, the force that caused acetabular instability was between 700 and 1000 N. In the models with 30 mm of medial wall defect all acetabular components were unstable under a force of 700 N.
Conclusions:
According to our results, acetabular component should be stable if the defect of the medial wall of the acetabulum is less than 68% of the diameter of the acetabular component or if the uncovered surface area of the acetabular component is not greater than 27%, and the force <700 N. For a load of 1000 N, the medial wall defect should not exceed 45% of acetabular component diameter or 18% of uncovered acetabular component surface.
Sindrom kubitalnog kanala susrećemo relativno često te on predstavlja značajan javnozdravstveni problem. Specifičnost tijeka ulnarnog živca niz ruku, a napose anatomski međuodnosi s koštanim i ...mekotkivnim strukturama u području lakta čine ga vrlo podložnim vanjskim utjecajima, ponajviše silama kompresije. Progresija parestezija na ulnarnoj strani četvrtog prsta i na čitavom petom prstu zahvaćene šake uz pojavu motoričke slabosti i atrofije mišića šake uvelike ograničava bolesnike, najčešće one koji se bave aktivnostima koje zahtijevaju da im je lakat duže vremena u fleksiji, da neometano obavljaju svakodnevne aktivnosti. Stoga je iznimno važno pravovremeno dijagnosticiranje sindroma koje se zasniva na iscrpnoj anamnezi i detaljnom kliničkom pregledu uz pomoć niza specifičnih testova koji su detaljno opisani u radu. Elektromioneurografijom možemo utvrditi stupanj kompresije ulnarnog živca te pratiti uspješnost daljnjeg liječenja. Blaži oblici sindroma kubitalnog kanala uspješno se liječe konzervativnim načinom, dok teže oblike sindroma te one koji su neosjetljivi na provedeno konzervativno liječenje treba liječiti kirurški. Metode kirurškog liječenja sindroma možemo podijeliti na one koje ostavljaju živac u ležištu u kubitalnom kanalu poput in situ dekompresije i medijalne epikondilektomije te na one tijekom kojih se živac premješta u novo ležište ispred i iznad medijalnog epikondila, što nazivamo antepozicijom ulnarnog živca. Sve opisane metode pokazale su se gotovo jednako uspješnima, no usprkos tomu istraživanja pokazuju da se u današnje vrijeme kao metoda izbora kirurškog liječenja sindroma kubitalnog kanala najčešće koristi in situ dekompresija.
Debonding of the porous coating from the acetabular component of a total hip endoprosthesis is a rare complication. Revision total hip arthroplasty for an unstable acetabular component with a ...debonded porous coating strongly fixed to the bone can be challenging, especially in elderly patients of poor overall health. In such patients, revision procedures should be as simple and safe as possible. We present our technique of solving that problem in a case of an 82-year-old female with bad general condition and unstable acetabular component of hip endoprosthesis. Because of extremely deficient bone stock, a well-fixed porous coating was left in acetabulum to serve as a “cage“, allowing cemented acetabular component placement. This procedure can reduce the risk of intraoperative bone fracture, blood loss, and duration of surgery, which is important in elderly patients with poor overall health.
Reumatoidni artritis kronična je, progresivna, sistemska upalna bolest koja u većine oboljelih dovodi do progresivnog razvoja deformiteta i gubitka funkcije šaka i ručnih zglobova praćenih bolima te ...uzrokujući teškoće u svakodnevnom životu. Kirurško liječenje ovih bolesnika ima ulogu u postizanju što bolje funkcije šake i ručnog zgloba, olakšavanju boli, ali i postizanju boljeg estetskog rezultata. U ranim fazama bolesti izvode se preventivni zahvati, kojima usporavamo prirodni tijek bolesti uklanjajući upaljeno i reaktivno tkivo. Oni popravljaju funkciju zgloba i snižavaju rizik od rupture tetiva i razvoja težih deformacija. U kasnijim fazama bolesti, kada su znatne promjene već nastupile, rekonstruktivnim kirurškim zahvatima pokušavaju se poboljšati funkcija i smanjiti bol ili zbrinuti rupture tetiva. Pri odluci o obliku liječenja u prvom su redu važni suradnja reumatologa i ortopeda te individualizirani pristup svakom bolesniku kako bi se odabrali najbolji oblik kirurškog zahvata, kao i najbolji trenutak za njegovo izvođenje.
Ovim kliničkim zapažanjem želimo upozoriti na osteoid osteom kao mogući uzrok tegoba u području distalne falange prstiju šake. Ta iznimno rijetka lokalizacija osteoid osteoma predstavlja problem za ...prepoznavanje i zbog atipične prezentacije. Dvadesetogodišnji bolesnik se pet godina žalio na bol u području jagodice IV. prsta desne šake koja je bila praćena oteklinom i crvenilom jagodice prsta te deformacijom nokta. Na rendgenskim snimkama vidjela se osteoliza u području baze distalne falange. Magnetskom rezonancijom je postavljena sumnja na osteoid osteom, što je potvrđeno kompjuteriziranom tomografi jom. Nakon kirurškog liječenja tijekom kojeg je osteoid osteom ekskohleiran, dolazi do potpunog nestanka tegoba. Potpuni oporavak bolesnika pokazuje i rezultat DASH upitnika, koji je već tri mjeseca nakon zahvata pao sa 54,5 na 0 što je prema tom upitniku uredan nalaz. Na osteoid osteom se uvijek mora posumnjati ako je oteklina distalne falange prsta s deformacijom nokta praćena bolovima koji se smanjuju korištenjem NSAIL. Metoda izbora u dijagnostici je kompjuterizirana tomografi ja koja mora biti načinjena tako da slojevi ne budu deblji od 1 do 2 mm. Zbog
blizine neurovaskularnih struktura i tetiva najboljim oblikom liječenja osteoid osteoma u području distalne falange prstiju šake smatra se kirurška ekscizija ili ekskohleacija.
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