Purpose
In this study, the functional mid-term outcomes of the modified Grammont and Langenskiöld technique was assessed in skeletally immature patients with habitual patellar dislocation, with ...emphasis on knee function, pain, and other possible post-surgical complications. This is the first study concerning the application of the modified Grammont and Langenskiöld technique in habitual patellar dislocations.
Methods
This retrospective cohort study considered 10 patients (15 knees), ranging from 7 to 11 years old, who underwent the modified Grammont and Langenskiold procedure between 2015 and 2018. History of dislocation, patellar stability and range of motion (ROM) were analysed. To assess functional improvement and knee pain, the Kujala Anterior Knee Pain Scale and KOOS-Child Knee Survey were used before and after surgical treatment.
Results
No history of dislocation was noted after surgical treatment. All 15 knees showed full ROM. There were no signs of genu recurvatum and no length discrepancies were found. The subjective assessment revealed significant improvement in the scores of the KOOS-Child questionnaire in all five sections (
p
< 0.001), as well as in The Kujala Anterior Knee Pain Scale (
p
= 0.001).
Conclusion
The modified Grammont and Langenskiöld technique yields remarkable results in terms of knee stability and knee function, while decreasing recurrence risk and intensity of pain in patients with challenging cases of patellofemoral joint dislocation. This surgical technique is most effective in cases where the patella remains dislocated continuously; however, it may also be used in immature patients with recurrent instability.
Level of evidence
IV.
Pain appearance is one the most common complication of spastic hip disease in children with cerebral palsy (CP). It determines child and caregiver quality of life and life priorities. Reconstruction ...hip surgery should be considered as a treatment of choice. Some clinical conditions give the inability to perform such a procedure. In our paper, we would like to present four palliative methods of spastic hip dislocation treatment in children with CP.
We analyzed four groups of patients treated because of hip pain. Inclusion criteria were pain appearance (visual analog scale-11 or numeric rating scale-11) and hip joint dislocation (migration percentage >80%). All patients were admitted to our department between 2008 and 2018. In the first group, patients were treated only by steroid injections to hip joints; in the second group, patients were recruits after hip interposition arthroplasty with shoulder spacer; in the third group, they were patients after valgus subtrochanteric osteotomy (Schanz); and in the fourth group, these were patients after proximal femoral resection (Castle procedure). The minimal follow-up time was 2 years. The first group consisted of 15 patients (15 hips) with a mean age of 15.5 (8-17) years; the second group, 20 patients (24 hips) with a mean age of 14.2 (9-22.6) years; the third group, 22 patients (24 hips) with a mean age of 13.5 (7-20.5) years; and the fourth group, 10 patients (15 hips) with a mean age of 12.9 (7-17.6) years.
Radiological evaluation was based on a standardized anteroposterior X-ray of the hip joints. Pain severity before surgery and at the last follow-up time was measured by visual analog scale-11. Parents or caregivers were asked about their child's pain during sitting, perineal care, and rest. During the visit, all caregivers were asked about treatment satisfaction (no 0 to max 10) and if they would decide again for the same surgery.
In all groups of patients, we observed a decrease in pain complaints. The observed reduction of pain in the first group was from 7.88 (4-10) to 3.08 (0-8) (
= 0.05), but results of injection were observed only for 4 months (2-8), and it has to be repeated (average: two times). In the second group, level of pain was reduced from 4.93 (1-10) to 0.93 (0-5) (
< 0.001); in the third group, from 6.22 (3-10) to 0.59 (0-6) (
< 0.001); and in the fourth group, pain reduces from 5.43 (2-10) to 2.13 (0-5) (
< 0.001). Observed changes concerned mostly sitting position and perineal care. The complication rate was in the second group, 6 of 24 cases of extraarticular ossification; in the third group, 2 of 24 cases with extraarticular ossification, two cases of revision surgery. In the fourth group, two cases needed another femoral resection. In the first group, five patients died during follow-up time, so they were excluded from the study. In the steroid injection group, parents' treatment evaluation was 6.83 (0-10), and only in three cases that they would resign from the treatment. In the hip interposition arthroplasty group, caregivers' evaluation was 7.41 (0-10), and in five cases, parents did not accept the surgery. In the Schanz osteotomy group, parents' evaluation was 5.9 (0-10), and in eight cases, caregivers would not repeat surgery. In the proximal femoral resection group, satisfaction was the highest, 8.3 (3-10), and only two parents would not decide for surgery again.
All procedures can be considered as palliative treatment options for pain complain in a spastic hip joint dislocation in children with CP. Steroid injections to the hip joint need to be repeated, and with the follow-up time, it becomes less effective. Steroid injection seems to be the treatment of choice for patients with general anesthesia contraindications. Interposition arthroplasty of the hip joint seems to give better final results, but the highest parents' satisfaction surprisingly was observed in the proximal femoral resection group, but differences were not statistically significant.
In recent years numerous initiatives aimed at reducing air pollution have been undertaken in Poland. The general objective was to examine the correlation between air pollution measured by the level ...of particulate matter ≤10 μm in diameter (PM
) and emergency hospitalizations due to chronic obstructive pulmonary disease (COPD) and asthma in 16 Polish cities (capitals of the regions).
The authors aimed to diagnose the situation across 16 cities over a 5‑year period (2014-2019). Data on the number of hospitalizations was retrieved from the national public insurance system, the National Health Fund. A total number of 22 600 emergency hospitalizations was analyzed (12 000 and 10 600 in 2014 and 2019, respectively). The data on air pollution was accessed via the public register of the Chief Inspectorate for Environmental Protection air quality database. The authors of this article have used the data on PM
daily exposure in each of the 16 cities in 2014 and 2019. Statistical methods included: non-parametric tests, a 2-stage modelling approach for time-series data, and multivariate meta-analysis of the results.
The results indicated that there was a statistically significant decrease in PM
concentration in 2019 in comparison to 2014 in all cities, mainly in the autumn and winter season. However, the correlation between the improvement in the air quality and a decrease in emergency hospitalizations due to asthma and COPD turned out to not be as strong as expected. The authors observed a strong correlation between PM
concentrations and hospitalizations due to asthma and COPD, but only when air quality norms were significantly above acceptable levels.
Air pollution measured by PM
concentration might be used as one of the predictors of the asthma and COPD emergency hospitalization risk, yet other factors like respiratory tract infection, health care organizational aspect, patient self-control, compliance and comorbidities should also be taken into consideration. Int J Occup Med Environ Health. 2024;37(1):110-27.
The European Convention of Human Rights along with the case law elaborated by the European Court of Human Rights set an international procedural standard of a fair trial. It exerts a predominant ...influence not only on the creation and interpretation of European regulations connected with access to court and basic principles of the European justice system, but also on the interpretation of national constitutional laws in the realm of civil procedure. Any evaluation of the impact of protecting human rights and fundamental freedoms on the form, shape and daily practice of the Polish justice system in terms of the remedies mechanism demands that a number of issues be taken into account, not only with regard to the imperative of securing the right to an effective remedy, but also the form and functioning of the same in Poland. They should be adequate in terms of protecting the interests of individual parties as well as public interest. The impact of Art. 10 of the Convention on the evolution of Polish law on protection of freedom of expression is invaluable. According to the analysis, ECtHR case law under Art. 10 of the ECHR has had a major influence on the decisions of Polish courts; in fact, in certain instances it led to significant changes in Polish legislation.
The European Convention of Human Rights along with the case law elaborated by the European Court of Human Rights set an international procedural standard of a fair trial. It exerts a predominant ...influence not only on the creation and interpretation of European regulations connected with access to court and basic principles of the
European justice system, but also on the interpretation of national constitutional laws in the realm of civil procedure.
Any evaluation of the impact of protecting human rights and fundamental freedoms on the form, shape and daily practice of the Polish justice system in terms of the remedies mechanism demands that a number of issues be taken into account, not only with regard to the imperative of securing the right to an effective remedy, but also the form and functioning of the same in Poland. They should be adequate in terms of protecting the interests of individual parties as well as public interest.
The impact of Art. 10 of the Convention on the evolution of Polish law on protection of freedom of expression is invaluable. According to the analysis, ECtHR case law under Art. 10 of the ECHR has had a major influence on the decisions of Polish courts; in fact, in certain instances it led to significant changes in Polish legislation.
Summary Background Effective control of asthma is the primary goal of its treatment. Despite an improved understanding of asthma pathogenesis and accessibility of novel therapies, the rate of ...uncontrolled asthma remains high. Objective To find potential factors associated with asthma control in patients with aspirin-exacerbated respiratory disease (AERD). Methods Clinical data were collected from a specifically structured questionnaire. Demographics, a history of upper airway symptoms, asthma course, exacerbations expressed as emergency department (ED) visits/hospitalizations, and asthma treatment were considered. Spirometry, skin prick tests, total IgE concentration, and blood eosinophil count were evaluated. Asthma control was assessed through the Asthma Control Test (ACT). Results Out of 201 AERD patients, 41 (20.4%), 69 (34.3%), and 91 (45.3%) had controlled, partially controlled, and uncontrolled asthma, respectively. A multivariate ordered logistic regression analysis revealed that hospitalizations for asthma in the previous 12 months (OR 2.88; 95%CI, 1.11–7.46), ED visits for asthma throughout its duration (OR 1.05; 95%CI, 1.004–1.10), and total IgE concentration (OR 1.28; 95%CI, 1.02–1.60) were positively associated with poor asthma control, whereas FEV1 values (OR 0.98; 95%CI, 0.96–0.99) and medical care at a referential specialty clinic (OR 0.50; 95%CI, 0.27–0.95) were positively associated with good asthma control. Conclusions The prevalence of uncontrolled asthma in AERD patients is high and similar to that observed in different asthmatic populations. Owing both to the specificity and complexity of the disease, AERD patients should stay under regular care of well experienced referential medical centers to ensure that this asthma phenotype is dealt with effectively.
The LHCb detector is a single-arm forward spectrometer designed for the efficient reconstruction decays of c- and b-hadrons. LHCb has introduced a novel real-time detector alignment and calibration ...strategy for LHC Run II. Data collected at the start of the fill are processed in a few minutes and used to update the alignment, while the calibration constants are evaluated for each run. This is one of the key elements which allow the reconstruction quality of the software trigger in Run-II, which fully includes the particle identification selection criteria, to be as good as the offline quality of Run-I. This approach greatly increases the efficiency, in particular for the selection of charm and strange hadron decays. We discuss strategy and performance of this novel approach, followed by a presentation of the recent developments implemented for the 2017 run of data taking, and with the performance and reconstruction quality achieved by the LHCb experiment in LHC Run-II.
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