20 YEARS FOLLOW-UP OF GORE-TEX POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Prije dvadesetak godina u Klinici za ortopediju ugrađivali smo umjetne ligamente, i to tip proteze ligamenta Gore-Tex (razgranati polytetrafluoroethylen) kao postupak spašavanja nestabilnih koljena. U 13 bolesnika koristili smo protezu ligamenta Gore-Tex za rekonstrukciju stražnje ukrižene sveze (engl. posterior cruciate ligament PCL). U pacijenta F. K. imali smo priliku nakon 20 godina od izvršene rekonstrukcije PCL-a izvršiti kliničku, artroskopsku, magnetskorezonantsku (MRI) i patohistološku evaluaciju. Zbog artrotskih promjena u koljenu u bolesnika je bilo potrebno izvršiti artroskopsku toaletu koljena. Tom prilikom se izvršila i artroskopska evaluacija ugradene proteze ligamenta Gore-Tex te se napravila biopsija za patohistološku analizu (PHD). Prethodno je napravljen MRI koji je pokazivao uredan kontinuitet i volumen PCLa uz uznapredovale artrotske promjene koljena. Nalaz MRI bio je sukladan kliničkom nalazu koji je pokazivao dobru stabilnost koljena. Tijekom artroskopije uz standardne ulaze koristio se i posteromedijalni ulaz radi boljeg prikazivanja PCL-a. Artroskopija je pokazala da je proteza ligamenta Gore-Tex u cijelosti obložena zadebljanom sinovijalnom membranom odnosno fibrozom, a kada se na jednom mjestu odstranila sinovijalna membrana vidjele su se karakteristične polytetrafluoroethylenske niti u kontinuitetu. Probatornom sondom dokazao se kontinuitet PCL-a, a potom se uzelo nekoliko komadića ovojnice umjetnog ligamenta za PHD. Isto tako uzelo se i nekoliko komadića sinovijalne membrane iz drugih dijelova koljena. Patohistološki nalaz je pokazao da nema upalne reakcije u sinovijalnoj membrani koljena, a u ovojnici proteze ligamenta Gore-Tex našlo se zrelo vezivno tkivo s prisustvom multinuklearnih orijaških stanica uz fragmente stranog polarizirajuceg materijala. Ovaj prikaz slučaja pokazuje dobru biokompaktibilnost te dobru stabilnost koljena nakon 20 godina od ugradnje proteze ligamenta Gore-Tex u bolesnika s izrazito nestabilnim koljenom. Zanimljivo je napomenuti da nije došlo do propadanja niti polytetrafluoroethylena.Twenty years ago the Gore-Tex expanded polytetrafluoroethylene (PTFE) prosthetic ligament was used as feasible salvage procedure in patients with failed, multiply operated knees, or knees with gross instability. At the Department of Orthopaedic Surgery we operated 13 patients and replaced the posterior cruciate ligament (PCL) with the Gore-Tex prosthetic ligament. Recently we had opportunity to evaluate clinical, arthroscopic, magnetic resonance imagining (MRI) and patohystologic (PH) findings in patient F. K. twenty years after the reconstruction. Due to osteoarthritic changes arthroscopic toilette of the knee was performed. On that occasion arthroscopic evaluation and biopsies for microscopic examination were carried out. MRI performed prior to arthroscopy revealed tidy continuity and volume of PCL with advanced arthritic changes of knee. MRI findings were consistent to clinical findings of good knee stability. Arthroscopy revealed the Gore-Tex prosthetic ligament completely coated with thicken synovial membrane i.e. fibrosis. Partial removal of the synovial membrane showed continuity of characteristic PTFE strands. The continuity of PCL was established by the probe. After that, few pieces of synovial membrane from sheath of PCL and from other parts of synovial membrane of the knee were taken. One PTFP strand of artificial PCL was collected as well. Patohystological findings clearly excluded inflammatory reaction in synovial membrane of the knee. Furthermore, synovial membrane of Gore-Tex prosthetic ligament sheath was found to contain mature fibrotic tissue with multinuclear giant cells and fragments of foreign polarizing material. This case report demonstrated good biocompatibility and good knee stability twenty years after replacement of the PCL with the Gore-Tex prosthetic ligament in patient with gross instability. It is interesting to mention that there was no deterioration of PTFE strands

20 YEARS FOLLOW-UP OF GORE-TEX POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Prije dvadesetak godina u Klinici za ortopediju ugrađivali smo umjetne ligamente, i to tip proteze ligamenta Gore-Tex (razgranati polytetrafluoroethylen) kao postupak spašavanja nestabilnih koljena. U 13 bolesnika koristili smo protezu ligamenta Gore-Tex za rekonstrukciju stražnje ukrižene sveze (engl. posterior cruciate ligament PCL). U pacijenta F. K. imali smo priliku nakon 20 godina od izvršene rekonstrukcije PCL-a izvršiti kliničku, artroskopsku, magnetskorezonantsku (MRI) i patohistološku evaluaciju. Zbog artrotskih promjena u koljenu u bolesnika je bilo potrebno izvršiti artroskopsku toaletu koljena. Tom prilikom se izvršila i artroskopska evaluacija ugradene proteze ligamenta Gore-Tex te se napravila biopsija za patohistološku analizu (PHD). Prethodno je napravljen MRI koji je pokazivao uredan kontinuitet i volumen PCLa uz uznapredovale artrotske promjene koljena. Nalaz MRI bio je sukladan kliničkom nalazu koji je pokazivao dobru stabilnost koljena. Tijekom artroskopije uz standardne ulaze koristio se i posteromedijalni ulaz radi boljeg prikazivanja PCL-a. Artroskopija je pokazala da je proteza ligamenta Gore-Tex u cijelosti obložena zadebljanom sinovijalnom membranom odnosno fibrozom, a kada se na jednom mjestu odstranila sinovijalna membrana vidjele su se karakteristične polytetrafluoroethylenske niti u kontinuitetu. Probatornom sondom dokazao se kontinuitet PCL-a, a potom se uzelo nekoliko komadića ovojnice umjetnog ligamenta za PHD. Isto tako uzelo se i nekoliko komadića sinovijalne membrane iz drugih dijelova koljena. Patohistološki nalaz je pokazao da nema upalne reakcije u sinovijalnoj membrani koljena, a u ovojnici proteze ligamenta Gore-Tex našlo se zrelo vezivno tkivo s prisustvom multinuklearnih orijaških stanica uz fragmente stranog polarizirajuceg materijala. Ovaj prikaz slučaja pokazuje dobru biokompaktibilnost te dobru stabilnost koljena nakon 20 godina od ugradnje proteze ligamenta Gore-Tex u bolesnika s izrazito nestabilnim koljenom. Zanimljivo je napomenuti da nije došlo do propadanja niti polytetrafluoroethylena.Twenty years ago the Gore-Tex expanded polytetrafluoroethylene (PTFE) prosthetic ligament was used as feasible salvage procedure in patients with failed, multiply operated knees, or knees with gross instability. At the Department of Orthopaedic Surgery we operated 13 patients and replaced the posterior cruciate ligament (PCL) with the Gore-Tex prosthetic ligament. Recently we had opportunity to evaluate clinical, arthroscopic, magnetic resonance imagining (MRI) and patohystologic (PH) findings in patient F. K. twenty years after the reconstruction. Due to osteoarthritic changes arthroscopic toilette of the knee was performed. On that occasion arthroscopic evaluation and biopsies for microscopic examination were carried out. MRI performed prior to arthroscopy revealed tidy continuity and volume of PCL with advanced arthritic changes of knee. MRI findings were consistent to clinical findings of good knee stability. Arthroscopy revealed the Gore-Tex prosthetic ligament completely coated with thicken synovial membrane i.e. fibrosis. Partial removal of the synovial membrane showed continuity of characteristic PTFE strands. The continuity of PCL was established by the probe. After that, few pieces of synovial membrane from sheath of PCL and from other parts of synovial membrane of the knee were taken. One PTFP strand of artificial PCL was collected as well. Patohystological findings clearly excluded inflammatory reaction in synovial membrane of the knee. Furthermore, synovial membrane of Gore-Tex prosthetic ligament sheath was found to contain mature fibrotic tissue with multinuclear giant cells and fragments of foreign polarizing material. This case report demonstrated good biocompatibility and good knee stability twenty years after replacement of the PCL with the Gore-Tex prosthetic ligament in patient with gross instability. It is interesting to mention that there was no deterioration of PTFE strands

Orofacijalna granulomatoza: prikaz slučaja

An 18-year-old girl was referred to the Department of Oral Medicine with upper lip swelling. She was in good general health and laboratory tests were within the normal range. Histopathologic diagnosis did not reveal the presence of granulomas. This is consistent with the finding that 30% of patients with orofacial granulomatosis do not have granulomas on their biopsies. The patient was treated with intralesional steroids once a week for three weeks. The lesion subsided, but not completely, and recurred partially after ketchup intake. This case report highlights the fact that in every patient with non-odontogenic facial or oral swelling, systemic diseases such as sarcoidosis, Crohn’s disease, tuberculosis, etc. must be excluded. Furthermore, it is not unusual that in patients with orofacial granulomatosis, noncaseating granulomas are absent in the histopathologic finding.Osamnaestogodišnja djevojka bila je upućena na Zavod za oralnu medicinu s oteklinom gornje usne. Inače je bila dobrog općeg stanja i laboratorijski nalazi bili su unutar normalnih raspona. Patohistološki nalaz bioptata usne nije pokazao prisutnost granuloma, što je u skladu s nalazima drugih autora, jer oko 30% oboljelih od orofacijalne granulomatoze nema granulome u bioptatu. Pacijentica je liječena intralezijskom primjenom kortikosteroida jednom tjedno tijekom tri tjedna te se oteklina većim dijelom povukla, ali se djelomice opet pojavila nakon uzimanja kečapa. Ovaj prikaz slučaja pokazuje kako je u pacijenata koji nemaju odontogeni uzrok otekline lica ili usta potrebno isključiti sistemske bolesti poput sarkoidoze, Crohnove bolesti, tuberkuloze i dr. Nadalje, nije neuobičajeno da se u bolesnika s orofacijalnom granulomatozom ne nađu granulomi u patohistološkom nalazu

Orofacial Granulomatosis: Case Report

An 18-year-old girl was referred to the Department of Oral Medicine with upper lip swelling. She was in good general health and laboratory tests were within the normal range. Histopathologic diagnosis did not reveal the presence of granulomas. This is consistent with the finding that 30% of patients with orofacial granulomatosis do not have granulomas on their biopsies. The patient was treated with intralesional steroids once a week for three weeks. The lesion subsided, but not completely, and recurred partially after ketchup intake. This case report highlights the fact that in every patient with non-odontogenic facial or oral swelling, systemic diseases such as sarcoidosis, Crohn’s disease, tuberculosis, etc. must be excluded. Furthermore, it is not unusual that in patients with orofacial granulomatosis, noncaseating granulomas are absent in the histopathologic finding

Physical properties of the HCT EUV source

The paper describes recent progress on the development of an EUV source based on a hollow cathode triggered gas discharge (HCT). The principle of operation has been described in previous publications. When operated with Xe, a repetition frequency up to 4 kHz, conversion efficiency of 0.55% inband radiation in 2 pi and a pinch size below 3 mm in length was demonstrated. Today's requirements on a commercial EUV source for volume production of wafers still exceed the current performance by large factors both in terms of output power and life time. This paper will discuss the roadmap to high power and will also show elements of the way to extended life time. Particular focus will be put onto the physical limits of Xe as radiator and the advantages of using Sn instead. It will be demonstrated that the spectral efficiency of Sn is a factor of 3 higher than Xe