RESUMEN
PURPOSE OF THE STUDY The purpose of the prospective randomised study was to assess the benefits of the platelet-rich fibrin (PRF) application during the anatomic anterior cruciate ligament reconstruction (ACLR) for tendon graft healing. MATERIAL AND METHODS The study included 40 patients with an isolated rupture of the anterior cruciate ligament in the knee. The MRI findings on the tendon graft were evaluated at 6 months and 12 months after the surgery in a total of 33 patients, namely in 10 women/23 men (21 right knee/12 left knee), with the mean age of 29.1 years and at the mean follow-up of 15.9 weeks after the injury. The randomisation using envelopes was carried out at the beginning of arthroscopy either in the group with the PRF application (Group 1) (17 patients) or in the group without the PRF application (Group 2) (16 patients). The followed-up patients underwent the ACLR with targeting the femoral tunnel through anteromedial portal using the autografts of m. semitendinosusand m. graciliswith Tightrope femoral fixation and Inion implant in tibia. In Group 1, during the surgery PRF was applied both in the drilled tunnels (intraosseously) and directly to the surface of the tendon graft itself (intraarticular part). The Group 2 was a control group in which the same intervention was performed, however without the PRF application. In the 6 th and 12 th month after the surgery, the signal intensity of the knee and occurrence of the ACL graft failure, bone (marrow) oedema rate near the tunnels were assessed by an independent radiologist using a 3 Tesla MRI. RESULTS In the 6 th and also in the 12 th postoperative month, neither a complete, nor a partial graft failure was found in the group with PRF, whereas in Group 2 a complete or a partial graft failure was observed in 12.5% (p = 0.23). In the 6th month, a bone marrow oedema near the intraosseous parts of the graft was reported in 94.1% of patients in Group 1 and in 81.3% of patients in Group 2, while in the 12 th month it was 23.5% of evaluated patients in Group 1 and 37.5% patients in Group 2. The differences between the two groups were not statistically significant in the 6 th (p = 0.096) or in the 12 th month (p = 0.43). In the 6 th month, a fully ligamentised graft was found in 52.9% of patients in Group 1 and in 37.5% of patients in Group 2 (p = 0.061), a partially ligamentised graft was present in 47.1% of patients in Group 1 and in 50% of patients in Group 2. In the 12 th month, a fully ligamentised graft was seen in 94.1% of patients in Group 1 and in 75% of patients in Group 2 (p = 0.26) and a partially ligamentised graft was present in 5.9% of patients in Group 1 and in 12.5% of patients in Group 2. In the remaining 12.5% of patients in Group 2, the finding was assessed as a graft with no signs of ligamentisation. DISCUSSION We have not encountered a paper in the Czech or world literature which would present results of a similar study, i.e. which would evaluate the potential benefits of the platelet-rich fibrin application in the course of the anatomic anterior cruciate ligament reconstruction. Majority of studies evaluate the benefits of the application of platelet-rich plasma aimed to achieve a positive effect on the LCA graft healing. CONCLUSIONS Our study proved a higher percentage of ligamentisation and healed grafts into the bone as well as a lower occurrence of graft failure in the group with PRF compared to the group without the PRF application, namely both in the 6 th and in the 12 th month. Nonetheless, the differences between the two groups assessed at the same time were not statistically significant. Key words: anterior cruciate ligament, arthroscopy, anatomic ACL reconstruction, magnetic resonance imaging of the graft, platelet-rich fibrin, graft healing, MRI signal intensity of the graft.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior/métodos , Imagen por Resonancia Magnética/métodos , Tendones/diagnóstico por imagen , Adulto , Ligamento Cruzado Anterior/patología , Lesiones del Ligamento Cruzado Anterior/diagnóstico por imagen , Artroscopía , República Checa/epidemiología , Femenino , Fémur/cirugía , Rechazo de Injerto/patología , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/patología , Articulación de la Rodilla/cirugía , Masculino , Fibrina Rica en Plaquetas/fisiología , Plasma Rico en Plaquetas/fisiología , Estudios Prospectivos , Rotura/patología , Tendones/trasplante , Tibia/cirugía , Trasplante AutólogoRESUMEN
INTRODUCTION: Tumors of appendix vermiformis are quite rare; they represent only about 0.4% of gastrointestinal tract tumors. They can be both benign and malignant (primary or secondary). Carcinoid is the most common tumor of the appendix. The symptoms can include nothing but non-specific abdominal pain, or on the contrary they can imitate inflammatory acute abdomen. Liver metastases are associated with an advanced stage of malignancy; their surgical treatment is presented rarely in the literature. The aim of this publication is to present two cases with different results of surgical treatment of liver metastases with the primary tumor located in the appendix. CASES: The first patient is a 50 years old female who underwent right hepatectomy for liver metastases of Goblet-cell carcinoid of the appendix in 2013 and died six months later due to tumor progression. The second patient is a 58 years old male, still alive, undergoing repeated liver and lung resections and RFA from 2009 due to metastases from appendix carcinoma. CONCLUSION: Examples of dissemination of malignant appendix tumors to the liver need to be evaluated individually. In indicated cases, surgical treatment of liver metastases is justifiable.Key words: tumors of appendix liver metastases surgical treatment.
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Neoplasias del Apéndice/patología , Carcinoma/patología , Neoplasias Hepáticas/secundario , Neoplasias del Apéndice/cirugía , Carcinoma/secundario , Carcinoma/cirugía , Femenino , Hepatectomía , Humanos , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana EdadRESUMEN
Goblet cell carcinoid (GCC) of the appendix is extremely rare, representing approximately 5% of all primary appendiceal neoplasms. Histologically there are three groups of GCC: group A (typical GCC), adenocarcinoma ex GCC signet ring cell type (group B), and adenocarcinoma ex GCC poorly differentiated carcinoma type (group C), which is the most aggressive. GCC metastasizes in 15-60% of cases, mainly to the ovaries, pelvis, abdominal cavity, ribs, vertebrae, and lymph nodes. Hematogenous metastasis to the liver or other parenchymal organs can occur, but this is very rare. The different organs metastases havent been described yet. The primary mode of treatment is radical surgical resection or debulking, followed by chemotherapy; however, patients with unresectable or recurrent GCC are candidates for systemic therapy. Here, we report a case of very aggressive GCC of the appendix, which had metastazed to the liver at the time of diagnosis and subsequently metastasized to the orbit.
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Neoplasias del Apéndice/patología , Tumor Carcinoide/secundario , Células Caliciformes/patología , Neoplasias Orbitales/secundario , HumanosRESUMEN
UNLABELLED: Abdominal aortic aneurysm (AAA) is related with higher age and poses a serious threat to the patient´s life. Aneurysms larger than 5.5 cm in diameter are indicated for open or endovascular repair. Giant aneurysms are rarely encountered due to a high risk of rupture. We present a case report of such a giang aneurysm and its open repair. KEY WORDS: abnominal aortic aneurysm - iliac artery aneurysm - open repair - complications.
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Aneurisma de la Aorta Abdominal/cirugía , Aneurisma Ilíaco/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Anciano , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Humanos , Aneurisma Ilíaco/diagnóstico por imagen , MasculinoRESUMEN
UNLABELLED: Castleman disease is rare diagnosis. It was first mentioned in literature in 1954 by doctor Castleman and Lown. It is rare sickness which primary affects lymfatic nodes. There are four histo-morfologic subtypes and two clinic manifestations (uni and mulicentric). Comon clinical picture is simple lymfadenopathy of neck, medistinal a retroperitonal lymfatic nodes. Signs of this disease are heterogenic and depend on histological subtype. Also prognosis depends on type of illness. It should take place as benign diagnosis (unicentric form) but also can be potencionally malignant form which shlould exacerbate to malignant lymfoproliferation (multicentric form). Authors present the case of 29 years old men with clinical manifestation (jundice, intermitent bowel obstruction) of lagre retroperitoneal tumor in subhepatal localization. The treatment was radical surgical extirpation, surgery was without complications. Definitive histological diagnosis was confirmed as hyaline-vascular type of Castleman disease. Because the patient´s clinical form was multicentric, he is now undergoing adjuvant oncological treatment. KEY WORDS: Castleman disease reproperitoneal tumor.
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Enfermedad de Castleman/diagnóstico por imagen , Neoplasias Retroperitoneales/diagnóstico por imagen , Adulto , Enfermedad de Castleman/complicaciones , Enfermedad de Castleman/patología , Diagnóstico Diferencial , Humanos , Obstrucción Intestinal/etiología , Ictericia/etiología , Masculino , Pronóstico , Neoplasias Retroperitoneales/patologíaRESUMEN
PURPOSE: To assess the benefit of 4D-CT angiography (4D-CTA) in determination and precise measurement of middle cerebral artery (MCA) occlusion in comparison to CTA. Possible relationship of measured occlusion lengths with recanalization after intravenous thrombolysis was analysed as a second objective. METHODS: Detailed evaluation of complete MCA occlusions in 80 patients before intravenous thrombolysis using temporal maximum intensity projection (tMIP) dataset, calculated from 4D-CTA and conventional single-phase CTA was performed. Further, manual measurement technique was compared to results of semiautomatic procedure (vessel analysis) as reference. Statistical analysis of correlation between MCA occlusion length and IVT efficacy (24 h recanalization rate according modified Thrombolysis In Myocardial Infarction criteria-mTIMI) was performed. RESULTS: The distal end of occlusion was identified in all patients using tMIP, but only in 48 patients (60%) using CTA. The manual measurement method was not statistically different and well correlated with reference tMIP-vessel analysis. (15.4 vs. 16.3 mm; p = 0.434; r = 97). In measurable occlusions by CTA, no significant difference was proved in manually measured lengths using tMIP and CTA (14.5 vs. 13.3 mm; p = 0.089). Favorable recanalization (mTIMI 2-3) was achieved in 37 patients (47%). Length of occlusion in M1 segment (p = 0.002) and M2 segment involvement (p = 0.017) were proved as independent negative predictors of recanalization. Using receiver operating characteristics analysis, the cutoff length of the M1 segment occlusion for favorable recanalization was found to be 12 mm. CONCLUSION: The feasibility of MCA occlusion assessment using tMIP datasets and benefit over conventional CTA were confirmed. The manual measurement method was proved as feasible and simple with good correlation to reference semiautomatic analysis. The significant correlation of the MCA occlusion length and early recanalization was found. The length of 12 mm was recognized as cut-off length for favorable recanalization.
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Monitoreo de Drogas/métodos , Infarto de la Arteria Cerebral Media/diagnóstico por imagen , Infarto de la Arteria Cerebral Media/tratamiento farmacológico , Terapia Trombolítica/métodos , Activador de Tejido Plasminógeno/administración & dosificación , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Angiografía Cerebral , Femenino , Fibrinolíticos/administración & dosificación , Tomografía Computarizada Cuatridimensional , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Pronóstico , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y Especificidad , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: The Non-âHodgkin-lymphoma (NHL) brain infiltration carries a poor prognosis. Because of relatively rare incidence, we decided to share our experience. PATIENTS AND METHODS: Retrospective analysis of patients with NHL brain infiltration dia-gnosed in 2001-â2011 at our university hospital. RESULTS: Twentyâ-seven patients with median age of 61 (range 42-â82) years were analyzed. The primary diffuse large cell Bâcell lymphoma of CNS was defined in 22/â27 (81%) patients, in the others systemic NHL was present. Median positivity of the proliferative marker Kiâ67 was 80%, the number of NHL lesions 1 (1-â8), diameter 28 × 30 × 29 (11 × 16 × 20 to 85 × 76 × 65) mm. The fundamental finding in brain lymphoma MRI imaging was lesion with predominantly homogenous contrast enhancement, diffusion restriction and collateral edema. Thirteen out of 27 (48%) patients underwent lumbar puncture, and lymphoma presence in fluid was detected in only two of them. The most frequent symptoms were limb paresis or hemiparesis (55%), bradypsichysm (22%), expressive aphasia (22%), cephalea (18%). Corticosteroid therapy, as a primary treatment option, was indicated in 15% of patients with a median overall survival of one month, CNS radiotherapy in 37% with a median survival of three months, and chemotherapy in 48% patients with a median overall survival 10 (2-â45) months. CONCLUSION: The brain lymphomas are rare and prognostically very unfavorable affection. When specifying brain focal lesions on MRI, it is necessary to consider this etiology and to elect imaging protocols with contrast agents and diffusion weighted sequence. Biopsy should be performed prior to start of corticosteroid therapy. Intensive chemotherapy or radiotherapy indication must be individually considered, and proposed treatment should be initiated immediately with a potential for somewhat prolonged survival.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Encefálicas/patología , Encéfalo/patología , Linfoma no Hodgkin/patología , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Encefálicas/mortalidad , Femenino , Humanos , Linfoma no Hodgkin/mortalidad , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pronóstico , Análisis de SupervivenciaRESUMEN
BACKGROUND: Chylous ascites is a rare complication of the gastrointestinal neuroendocrine tumor. There are two mechanisms of its origin: mechanical obstruction by the tumor mass and fibrosis of the surrounding tissue due to overproduction of serotonin. Its presence restricts treatment options. CASE: We report a case of 66year old man suffering from recurrent diarrhoea and ascites. We found elevated tumor marker Chromogranin A and elevation of hydroxyindoleacetic acid (5-âHIAA) in the urine. A subsequent wholeâbody scintigraphy scan by octreoscan confirmed multinodal process with increased somatostatin receptors activity in the wall of the ileum, rectosigmoideum, lymph nodes of the retroperitoneum and mesenterium and left supraclavicular area. We performed bio-psy from the lymph node of supraclavicular area, and there was metastasis of the neuroendocrine tumor. Start of cytostatic therapy was repeatedly complicated by recurrent massive chylous ascites. The patient underwent only one series of palliative chemotherapy. Another procedure was again complicated by chylous ascites that caused hospitalization at the internal department, and the patient died four months after dia-gnosis. CONCLUSION: Chylous ascites is a very rare complication of gastrointestinal neuroendocrine tumor. It is not only a marker of poor prognosis, but also a complication that makes systemic treatment very difficult.
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Ascitis Quilosa/etiología , Neoplasias del Íleon/complicaciones , Tumores Neuroendocrinos/complicaciones , Anciano , Biomarcadores de Tumor , Ascitis Quilosa/diagnóstico , Resultado Fatal , Humanos , Neoplasias del Íleon/diagnóstico , Masculino , Tumores Neuroendocrinos/diagnóstico , Cuidados PaliativosRESUMEN
Double gallbladder, a congenital anatomic variation, represents approximately 2% of all congenital anatomic variations of the gastrointestinal tract, its incidence amounting to about 25 in 100 000. It has several types classified according to Boyden's criteria. The diagnostic method of first choice is ultrasonography. When the patient has no health complaints and cholecystolithiasis is present, no special treatment measures are required. The treatment option in symptomatic cholecystolithiasis is laparoscopic cholecystectomy. Only a few cases of double or triple gallbladder, in contrast to the high number of cholecystectomies, have been published in literature. The authors present a case of double gallbladder where the diagnosis was established more than three years after laparoscopic cholecystectomy