About some human errors met in treatment of tibial bone defects by Ilizarov method

Catedra de ortopedie și traumatologie, USMF „Nicolae Testemițanu”, Clinica de chirurgie plastică și microchirurgie reconstructivă a locomotorului, IMSP IMU, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Introducere. Tratamentul defectelor osoase prin metoda Ilizarov este de durată. Totuşi, in unitatea medicală pacientul se află doar la etapele sângerânde şi dureroase ale tratamentului restul perioadei se petrece în condiţii de ambulator. De aici, este evident că responsabilitatea pentru întreg tratamentul aparţine nu doar unui medic, dar unui grup de persoane inclusiv pacientul sau/şi rudelor lui. Scopul. Trecerea în revistă a erorilor depistate la tratamentul defectelor osului tibial prin metoda Ilizarov şi evidenţierea posibilităţilor de rezolvare a lor. Material şi metodă. Lucrarea este efectuată asupra 65 de cazuri clinice de tratament a defectelor circulare de tibie. În cadrul lotului studiat au dominat bărbaţii cu 48 cazuri faţă de femei cu 14. Lungimea maximală a defectului de os tibial recuperat a constituit 21 cm– minimală 5 cm. Erorile umane depistate de noi s-au înregistrat la etapa de spitalizare şi de tratament ambulator. La etapa de spitalizare am constatat iniţierea egalizării lungimii gambei in prezenţa fibulei consolidate cu scurtare–2;leziuni vasculare asociate osteotomiilor-4; trecerea cu broşele la limita articulaţiilor învecinate osului–4;şi construirea incorectă a modulelor fixatorului extern–4.La etapa de tratament ambulator ne-am întâlnit cu distracţii grăbite (urgentate)–3 şi tracţiune incorectă (pe un fragment nefracturat al gambei)–3; Rezultate. Toate erorile au dusa la complicaţii grave: scurtare de membru, segment doloros, rupere de broşe, artrite reactive, instabilitate fixator, infecţii, defecte tegumentare, etc. Depăşirea lor a marit numărul intervenţiilor chirurgicale per pacient. Concluzii. Erorile umane depistate la tratamentul defectelor osului tibial prin metoda Ilizarov aparţin atât de cadrul medical cât şi de persoanele tratate şi influenţează direct cheltuielile şi durata de tratament.Introducere. The treatment of bone defects by Ilizarov method is lengthy. However, in the medical unit the patient is at bleeding and painful stages of treatment, the remaining period is going on ambulatory. Hence,it is obvious that the responsibility for the whole treatment belongs not just to doctor, but to a group of people including patient and /or his relatives. Purpose. To review the errors detected in the treatment of tibial bone defects by Ilizarov method and highlighting the ways of solving them. Material and methods. The paper reflects the analysis carried out on 65 clinical cases of treatment of circular tibial defects. The study group was dominated by men–48 cases, women being 14 cases. The maximum length of recovered tibial bone defect was 21 cm, the minimal-5 cm. Human errors detected by us were recorded at the stage of hospitalization and ambulatory treatment. At the stage of hospitalization we detect the beginning of equalize of leg’s length in the presence of consolidated fibula with shortenin-2; vascular injury associated osteotomies-4; brooches passage at limit of surrounding bone joints-4; incorrect building of external fixator modules- 4.At ambulatory treatment stage we met rushed distractions (urged)-3 and incorrect traction (on a non fractured fragment of the calf)–3. Results. All errors led to serious complications: limb’s shortening, painful segment, brooches breaking, reactive arthritis, fixator’s instability, infections, tissues defects etc. Overcoming them increased number of surgical procedures per patient. Conclusions. Human errors detected in the treatment of tibial bone defects by Ilizarov method belong to both, the medical and the treated persons, and affect the costs and duration of patient's treatment

Complications in treatment of tibial bone defects using Ilizarov procedure

Catedra de ortopedie și traumatologie, USMF „Nicolae Testemițanu”, Clinica de chirurgie plastică și microchirurgie reconstructivă a locomotorului, IMSP IMU, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Introducere. Defectele osului tibial reprezintă cu adevărat o provocare pentru specialiştii ortopezi, tibia fiind unul din cele mai mari oase ale scheletului, deseori nu-şi găseşte suficiente „rezerve” de ţesut osos în organism pentru a compensa pierderile posttraumatice. Îndeosebi în defecte circulare această „criză” de ţesut osos este resimţită într-atât încât unica soluţie viabilă de a păstra membrul rămâne metoda calus-distracţie. Scop. Trecerea în revistă a complicaţiilor manifestate pe parcursul tratamentului defectelor circulare diafizare de tibie şi măsurile efectuate în depăşirea reuşită a lor. Material şi metode. În lucrare este adusă analiza efectuată asupra 65 de cazuri clinice de tratament a defectelor circulare de tibie. În cadrul lotului studiat au dominat bărbaţii cu 48 cazuri faţă de femei cu 14. Lungimea maximală a defectului de os tibial recuperat a constituit 21 cm – minimală 5 cm. Complicaţiile mai des întâlnite au fost: Infectarea ţesuturilor în jurul broşelor (la toţi pacienţii); defecte de părţi moi asociate celor osoase - 92%; infecţii la fragmentele osoase – 17,8%; consolidări întârziate 56%; pseudartroze – 18%; rupere broşe – 7%; hemoragii intraoperatorii – 4,7%; neformare regenerat osos matur satisfăcător – 3,8%; redori articulare – 88%; scurtare de segment – 92%; dezaxare – 12%, edemul gleznei şi piciorului – 18%; artrite reactive – 15%; răspuns alergic şi exematic local – 3%; segment dureros – 5,5% şi osteoporoză locală la 11%. Rezultate. La toţi pacienţii scopul pretins de noi a fost realizat. Concluzii. Complicaţiile postoperatorii la tratamentul defectelor osului tibial prin metoda Ilizarov sunt inevitabile. Aceasta impune o conduită postoperatorie cu monitorizări frecvente indiferent de durata de la intervenţia chirurgicală.Introduction. Tibial bone defects represents really a challenge to orthopedic specialists because tibia, as one of the biggest bones of the skeleton, often can not find enough bone "reserves" in the body to compensate the post traumatic losses. Especially in circular defects, this bone tissue “crisis” is felt intractable that the only viable solution to keep member remains callus distraction method. Purpose. To review the complications manifested during treatment of circular diaphyseal tibial defects and the measures undertaken to overcome them successfully.Material and methods. The paper reflects the analysis carried out on 65 clinical cases of treatment of circular tibial defects. The study group was dominated by men – 48 cases, women being 14 cases. The maximum length of recovered tibial bone defect was 21 cm, the minimal - 5 cm. Most common complications were: infection of the tissues around brooches – 100%; soft tissue defects associated with bone defects- 92%; infections of the bone fragments - 17.8%; 56% delayed consolidation; non unions - 18%; brooches breaking- 7%; intraoperative bleeding - 4.7%; non formation of satisfactory regenerated mature bone- 3.8%; joint stiffness - 88%; segment’s shortening- 92%; misalignment - 12%, ankle and foot edema- 18%; reactive arthritis- 15%; allergic and local exematic response- 3%; painful segment - 5.5% and 11%- local osteoporosis. Results. In all patients claimed purpose has been achieved. Conclusions: postoperative complications of tibial bone defects treatment by Ilizarov method are inevitable. This requires a postoperative conduct with frequent monitoring recklessly the period after the surgery

Treatment of the posttraumatic damage of the pelvic limb in patients with diabetes

Catedra de ortopedie și traumatologie, USMF ”Nicolae Testemițanu”, Clinica de chirurgie plastică și microchirurgie reconstructivă a locomotorului, IMSP IMU, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Introducere. Riscul de fractura a piciorului la persoanele cu diabet zaharat este legat de existenta neuropatiei diabetice periferice, ce reprezintă un factor important in dezvoltarea defectelor piciorului, infecțiilor si amputațiilor de membre inferioare Scop. Analiza defectelor posttraumatice in asociere cu polineuropatia diabetica a membrului pelvin si posibilități de acoperire a acestora. Material și metodă. Cei 15 pacienți au fost împărțiți in 4 categorii: lambouri de vecinătate, lambouri la distanta, plastie cu piele libera despicata, amputație. Parametrii urmăriți sunt: vârsta, sex, tipul diabetului zaharat, localizarea. Rezultate. 4 femei si 11 bărbați au fost repartizați in 4 categorii după tipul intervențiilor chirurgicale: plastii cu lambouri de vecinătate 4, lambouri la distanta 2, plastie cu piele libera despicata 7, amputație 2. Din lotul total de pacienți cu diabet zaharat tip II au fost 12 pacienți, iar 3 pacienți cu diabet zaharat insulin-dependent. Cei 15 pacienți, care au beneficiat de reconstrucții prin lambouri, au avut defecte la gamba distala si picior, iar pacienții care au suferit amputație per primam, au avut leziuni la nivelul gambei proximale, care au constat in necroze tegumentare si de părți moi, cu afectare osoasa si osteita, semn al gradului avansat al afectării vasculare. La pacienții care au beneficiat de plastie cu piele libera despicata, majoritatea defectelor au fost la nivelul gambei si erau prezente leziuni tegumentare. Concluzii. Defectele posttraumatice la pacienții cu polineuropatii diabetice a membrului pelvin pot fi rezolvate prin plastie cu piele libera despicata, reconstrucții prin lambouri, astfel rata amputațiilor scade.Introduction. Leg fracture risk at people with diabetes is related to the existence of diabetic peripheral neuropathy, which is an important factor in the development of foot defects, infections and amputations of lower limb. Purpose. Analysis of the posttraumatic damage coupled with diabetic polyneuropathy of the pelvic limb and possibilities of healing the defects. Material and methods. The 15 patients were divided in 4 subgroups according to the type of surgical procedure performed: split skin grafts, the neighboring flaps, distant flaps, amputation at different levels. The descriptive parameters included: age, gender, the presence of type I or type II diabetes, the location. Results. 15 patients included in this study, out of which 4 women and 11 men were divided into four subgroups based on type of performed surgeries: the neighboring flaps - 4, distant flaps - 2, split skin grafts - 7, amputation in 2 cases. 12 patients had diabetes of type II, and the remaining 3 patients were insulin dependent. The 6 patients who had reconstruction through flaps, had distal defects (foot or ankle), whereas the patients who suffered per primam amputation had lesions at the ankle which were skin and soft tissue necrosis, with bone disease and osteitis, with signs of severe vascular disease. The majority of patients who had benefited from split skin grafts, suffered from skin lesion at the ankle level. Conclusions. Posttraumatic defects in patients with diabetic polyneuropathy of the pelvic limb can be treated through flaps or split skin grafts, so the amputation rate decreases significantly

Loco-regional flap in treatment of actinic skin defect

Catedra de ortopedie și traumatologie, USMF „Nicolae Testemițanu”, Clinica de chirurgie plastică și microchirurgie reconstructivă a locomotorului, IMSP IMU, Catedra de morfopatologie, USMF „Nicolae Testemițanu”, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Introducere. La ora actuala tehnicile de plastie utilizate in tratamentul defectelor postexcizionale sunt in mare parte standardizate, însă în practica medicală, ne confruntam cu pacienții care au fost supuși radioterapiei. La această categorie de pacienți plastia reconstructivă impune o serie de întrebări majore, determinate de modificările pe care radiațiile ionizante le produc la nivelul țesuturilor supuse radioterapiei. Caz clinic. Lucrarea reflecta cazul clinic al unui bărbat de 61de ani supus radioterapiei după excizia formațiunii tumorale de la nivelul treimii superioare a intestinului rect. La o distanta de 2 ani după curele de radioterapie,in regiunea sacrala,tratata actinic,apare o zona de necroza de aproximativ 20x20 cm. Preoperator, zona modificata actinic a fost divizata schematic in 3 sectoare, limita dintre ele fiind intensitatea modificărilor distrofice determinate vizual. In timpul intervenției chirurgicale in exereza au fost incluse toate cele 3 sectoare, rezultând un defect in regiunea sacrala de aproximativ 20x20 cm. Conform planului de pregătire preoperatorie s-a efectuat plastia defectului cu lambou fesier bilateral,locul donator fiind închis prin sutura directa in aceeași etapa. Postoperator zonele demarcate anterior au fost separate si studiate histologic pentru determinarea exacta a zonei viabile din punctul reversibilității proceselor distrofice . Concluzie. Zona țintă pentru studiere histologica este zona II, unde examenul este informativ referitor la gradul de afectare a pielii si țesuturilor moi subadiacente. Integrarea țesuturilor transplantate din alta regiune in cazul defectelor tegumentare actinice pot avea loc după depășirea zonei II, zona III fiind descrisa histologic cu potențial de regenerare. Un examen histo-patologic preoperator al zonei actinice, permite determinarea marginii țesuturilor viabile, păstrând in unele cazuri arii de țesuturi importante.Introduction. Plasty techniques currently used in the treatment of the defects are largely standardized. But in clinical practice, quite often we are faced with patients who were undergoing radiation therapy. In this patient’s category, reconstructive plastic surgery requires a series of questions determined by major changes produced by ionizing radiation to tissues after underwenting radiotherapy. Clinical case. This work reflects a clinical case of a man of 61 years old, that was submit to radiation therapy after tumoral excision, manifested at the level of the third upper part of the large intestine, rectum. At a distance of 2 years after radiotherapy, in the treated actinic sacral region, there was an area of necrosis of about 20x20cm. The area that was actinic changed was divided in 3 fields, the limit between them being visually. During surgery, it have been included all 3 fields, that created a defect in the sacral region, of about 20x20cm. According to the pre surgery plan, it has been done defect’s plasty with gluteal flap on the both parts, the donor place being closed by direct suture at the same stage. After surgery, the demarcated area were separated and studied histological for determination of the viable area. Conclusions. Target area for histological examination is the No.2 area, where examination is indicative in the damage of the skin and soft tissue. The integration of the tissues and organ transplant from another area in the case of actinic defect, may take place after exceeding the second field, histological appreciated with regenerative potential. A preoperative histopathology of actinic area determines the edge of the viable tissue, in some significant cases-areas with important tissue

Plasty of ankle and foot defects caused by the skin squamous cancer

Catedra de ortopedie și traumatologie, USMF „Nicolae Testemițanu” Clinica de chirurgie plastică și microchirurgie reconstructivă a locomotorului, IMSP IMU, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Scopul. Tratamentul defectelor gleznei și piciorului generate de cancerul pavimentos al pielii cu lambouri locoregionale. Material și metode. Materialul prelucrat în lucrare a fost reprezentat de 8 pacienți care au suferit intervenții chirurgicale pentru ablația formațiuni tumorale din regiunea gleznei și piciorului. Pentru acoperirea defectelor rezultate sau utilizat următoarele tipuri de lambouri: tibial posterior perforant (2), perforant fibular (1), supramaleolar (2), safen perforant (1), perforant peronier (1), prin avansare (1). Criteriile după care au fost monitorizați pacienții include: procesul de integrare a lamboului în patul receptor, prezența/absența recidivelor și funcția la distanță a zonei interesate. Rezultate. Din lotul total de 8 pacienți incluși în studiu și urmăriți la distanțe diferite de timp s-au înregistrat următoarele rezultate: un caz de cicatrizare secundară, un caz de recidivă a cancerului (în zona adiacentă lamboului) și un caz a necesitat o intervenție chirurgicală repetată, pentru ajustare estetică (la insistența pacientei). În celelalte cazuri, rezultate bune. Concluzii. Defectele generate de cancerul pavimentos al pielii de la nivelul gleznei și piciorului pot fi acoperite cu țesuturi durabile, bine vascularizate al lambourilor loco-regionale, fiind o soluție satisfăcătoare.Purpose. Treatment of ankle and foot defects caused by squamous skin cancer of loco-regional flaps. Materials and methods. In the material we discuss about 8 patients that had ablation of tumor at the ankle and foot. For covering the defects, we use the following types of flaps: perforator posterior tibial (2), perforator fibular (1), supramalleolar (2), perforator saphenous (1), by submission (1), peroneal perforator (1). The criteria through which we monitored patients were: integration of the flap, presence or absence of relapses, function at the distance of the concerned area. Results. In total group of 8 patients that were in the study followed-up at different time period, were recorded the following results: a case of secondary scarring, one case of cancer recurrence (in the adjacent flap) and one case has required repeated surgery, for aesthetic adjustment. In other cases - good results. Conclusion. Defects caused by the skin squamous cancer of the ankle and foot tissues can be coated with vascularized skin of the loco-regional flaps

g factors of coexisting isomeric states in Pb-188

The $g$ factors of the ${12}^{+}$, {11}^{\ensuremath{-}}, and {8}^{\ensuremath{-}} isomeric states in $^{188}\mathrm{Pb}$ were measured using the time-differential perturbed angular distribution method as g({12}^{+})=\ensuremath{-}0.179(6), g({11}^{\ensuremath{-}})=+1.03(3), and g({8}^{\ensuremath{-}})=\ensuremath{-}0.037(7). The $g$ factor of the ${12}^{+}$ state follows the observed slight down-sloping evolution of the $g$ factors of the ${i}_{13/2}^{2}$ neutron spherical states with decreasing $N$. The $g$ factors of the {11}^{\ensuremath{-}} and {8}^{\ensuremath{-}} isomers proposed as oblate and prolate deformed states, respectively, were interpreted within the rotational model, using calculated and empirical $g$ factor values for the involved single-particle orbitals

The biocompatibility of titanium in a buffer solution: compared effects of a thin film of TiO2 deposited by MOCVD and of collagen deposited from a gel

This study aims at evaluating the biocompatibility of titanium surfaces modified according two different ways: (i) deposition of a bio-inert, thin film of rutile TiO2 by chemical vapour deposition (MOCVD), and (ii) biochemical treatment with collagen gel, in order to obtain a bio-interactive coating. Behind the comparison is the idea that either the bio-inert or the bio-active coating has specific advantages when applied to implant treatment, such as the low price of the collagen treatment for instance. The stability in buffer solution was evaluated by open circuit potential (OCP) for medium time and cyclic voltametry. The OCP stabilized after 5104 min for all the specimens except the collagen treated sample which presented a stable OCP from the first minutes. MOCVD treated samples stabilized to more electropositive values. Numeric results were statistically analysed to obtain the regression equations for long time predictable evolution. The corrosion parameters determined from cyclic curves revealed that the MOCVD treatment is an efficient way to improve corrosion resistance. Human dermal fibroblasts were selected for cell culture tests, taking into account that these cells are present in all bio-interfaces, being the main cellular type of connective tissue. The cells grew on either type of surface without phenotype modification. From the reduction of yellow, water-soluble 3-(4,5-dimethyldiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT cytotoxicity test), MOCVD treated samples offer better viability than mechanically polished Ti and collagen treated samples as well. Cell spreading, as evaluated from microscope images processed by the program Sigma Scan, showed also enhancement upon surface modification. Depending on the experimental conditions, MOCVD deposited TiO2 exhibits different nanostructures that may influence biological behaviour. The results demonstrate the capacity of integration in simulated physiologic liquids for an implant pretreated by either method

Spectroscopy of odd-mass cobalt isotopes toward the N=40 subshell closure and shell-model description of spherical and deformed states

The neutron-rich cobalt isotopes up to A = 67 have been studied through multinucleon transfer reactions by bombarding a 238U target with a 460-MeV 70Zn beam. Unambiguous identification of prompt γ rays belonging to each nucleus has been achieved using coincidence relationships with the ions detected in a high-acceptance magnetic spectrometer. The new data are discussed in terms of the systematics of the cobalt isotopes and interpreted with large-scale shell-model calculations in the fpgd model space. In particular, very different shapes can be described in 67Co, at the edge of the island of inversion at N = 40, where a low-lying highly deformed band coexists with a spherical structureThis work was partially supported by the European Community FP6, Structuring the ERA Integrated Infrastructure Initiative Contract No. EURONS RII3-CT-2004-506065, by MICINN, Spain (Contract No. FPA2011-29854), by IN2P3, France (Contract No. AIC-D-2011-648), by Comunidad de Madrid, Spain (Contract No. HEPHACOS S2009-ESP-1473), and by Generalitat Valenciana, Spain (Contract No. PROMETEO/ 2010/101). A. Gadea and E. Farnea acknowledge the support of MICINN, Spain, and INFN, Italy, through the AIC-D-2011-0746 bilateral actio

Oblate collectivity in the yrast structure of 194Pt

A deep inelastic reaction using a 460 MeV 82Se beam incident upon a thick 192Os target was performed at the Legnaro National Laboratory, Italy. The resulting γ-decays were measured using the GASP array. Results for 194Pt extend the known level scheme of the yrast structure from spin I = (12 ħ) to (20 ħ). The irregularities in the sequence of the new transition energies and total Routhian surface calculations show a breakdown in collectivity with an yrast oblate shape remaining to high spin.Rubio Barroso, Berta, [email protected]