Cardiomegaly in tropical Africa

The term cardiomegaly is found in 5–7% of chest X-ray film evaluations in tropical Africa. However, cardiomegaly is a descriptive term, devoid of any aetiological meaning. Therefore, providing information about the aetiological factors leading to heart enlargement in a group of Africans (Nigerians) was the purpose of this study. In the years 2002–2011, 170 subjects (aged 17–80 years, mean age 42 years) in whom cardiomegaly was revealed by chest radiographs were studied at the Madonna University Teaching Hospital, Elele. The patients underwent echocardiography, electrocardiography, and several appropriate laboratory tests. Arterial hypertension was found to be most frequently associated with heart enlargement (39.4%), followed by dilated cardiomyopathy (21.76%), endomyocardial fibrosis (14.1%), valvular defects (9.4%), cardiac enlargement in the course of sickle-cell anaemia (6.47%), and schistosomal cor pulmonale (3.52%). This study is a contribution to a better aetiological elucidation of cardiomegaly in the tropics and emphasizes the importance of arterial hypertension as one of its causative factors. The dire need for effective treatment of hypertensive patients becomes evident. A high prevalence of elevated blood pressure seems to reflect an impact of civilization-related factors on the African communities

Treatment of the dens fractures in children

The anatomical and biomechanical features of the immature cervical spine make the upper segments at C1–3 especially susceptible to injury. Material and method From 2000 to 2016, 10 patients (3 boys, 7 girls) with C2 dens fractures were treated. The average age of each child was 11 years (3–17). According to the Anderson classification, there were 6 patients with a type III fracture and 4 with a type II. 4 patients were treated conservatively using the Minerva cervical brace for 75 days (66–125) and 6 patients by means of the Halo-Vest for 79 days (64–87) and followed by the Schantz collar for 17 days (2–35). Results The follow up lasted 78 months (12–180). The NDI (Neck Disability Index) score was calculated for each patient, except for section 8 (driving the car). The scores ranged from 1/45 (2.22%) to 20/45 (44.44%). The mean score for 9 out of the 10 patients (one patient died) was 4.77 (10.61%). Conclusion The C2 dens fracture is a rare injury in children. The classification system of dens fractures developed by Anderson is useful in choosing the mode of treatment of dens fractures

Interpopulation study of medical attendance aboard a cruise ship

The study carried out aboard a cruise ship in the years 1993 – 1998 involved ship passengers of various nationalities including 3872 Germans aged 23 – 94 years and 1281 Americans aged 25 – 94 years. Both nationality groups were divided into two age subgroups: till 64, and 65 – 94 years. The German younger age subgroup (mean age 53,2 years) consisted of 59% of the passengers, whereas the 65 – 94 years subgroup (mean age 72 years) was made up of 41% of the ship`s passengers. On the other hand, 73% of the Americans belonged to the 65 – 94 years subgroup (mean age 73,4 years), whereas 27% to the younger one (mean age 52,8 years). The number of onboard consultations and their causes were determined. The occurrence of chronic illnesses in both 65 – 94 years subgroups was assessed by means of a questionnaire. A higher frequency of consultations was found in the Germans (24,38%) than in the Americans (14,05%) (p = 0,001). The difference was particularly striking in the people over 65 years of age (30,87% of the Germans as compared with 14,22% of the Americans, p = 0,001).The Germans were nearly 4-times more frequently seen than the Americans for cardio-vascular diseases and almost 3-times more often because of gastrointestinal disorders. The discrepancies in the consultation rates were mainly caused by the different insurance systems of both nations. Chronic illnesses as estimated by means of the questionnaire prevailed in the German passengers. The statistically significant differences (13,3% versus 20%, p = 0,01 and 0,001) regarded the locomotor system, urinary tract diseases and a group of illnesses including neurological, ophthalmological, ear, skin, malignant diseases and diabetes

Enhancement of cartilage repair through the addition of growth plate chondrocytes in an immature skeleton animal model

Background: The treatment of articular cartilage damage is a major clinical problem. More often, this clinical issue affects children, which forces doctors to find the best treatment method. Methods: The aim of this experimental study on 2-month-old Landrace pigs was to compare the results of two cartilage defect treatments: (1) filling the cartilage defect with a scaffold incubated with bone marrow aspirate supplemented with growth plate chondrocytes (the CELLS group) and (2) filling the cartilage defect with an empty scaffold implanted after drilling the subchondral bone (the CTRL group). The treatment outcomes were assessed macroscopically and microscopically. Results: Based on the macroscopic evaluation, all animals showed a nearly normal morphology, with an average of 9.66/12 points (CTRL) and 10.44/12 points (CELLS). Based on the microscopic evaluation, 1 very good result and 8 good results were obtained in the CTRL group, with an average of 70.44%, while 5 very good results and 4 good results were obtained in the CELLS group, with an average of 79.61%. Conclusions: (1) Growth plate chondrocytes have high chondrogenic potential and thus offer new possibilities for cartilage cell therapy. (2) The implantation of a scaffold loaded with bone marrow-derived MSCs (mesenchymal stem cells) and growth plate chondrocytes into a cartilage defect is a good therapeutic method in immature patients. (3) Cartilage repair based on a scaffold with bone marrow aspirate-derived cells supplemented with autologous growth plate chondrocytes achieves better results than repair with marrow stimulation and a hyaluronic acid-based scaffold (overall microscopic rating). (4) Chondrocyte clustering is a manifestation of the cartilage repair process but requires further observation

Statistical image analysis and escort histograms in characterization of articular cartilage repair in a skeleton animal model

Statistical image analysis of an ensemble of digital images of histological samples is performed as an auxiliary investigation a result of the recently proposed method of articular cartilage repair utilizing growth plate chondrocytes in a skeleton animal model. A fixed–shift model of maximal likelihood estimates of image histograms applied for monochromatic (grayscale) images or their RGB components confirms the statistically significant effect of the previously proposed medical treatment. The type of staining used to prepare images of histological samples is related to the visibility of the effectiveness of medical treatment. Hellinger distance of escort distributions for maximal likelihood estimates of image histograms of medically treated and control samples is investigated to identify grayscale (or RGB) intensities responsible for statistically significant difference of the estimates. A difference of Shannon entropy quantifying informational content of the histograms allows one to identify staining and image colors which are most suitable to visualize cluster formation typical for articular cartilage repair processes

Humeral Capitellum Fractures in Adolescents: A Study of 6 Cases Treated by Open Reduction and Internal Fixation with Bioabsorbable Nails

Purpose. The purpose of our study was to evaluate the clinical outcome following open reduction and internal fixation of humeral capitellum fractures in adolescents and to assess the usefulness of bioresorbable implants in that procedure. Due to the rarity of these fractures, there are not many studies dealing with the problem in the literature. Methods. We retrospectively evaluated a group of 6 skeletally immature patients aged 10.6–15.3 treated at our department from January 2015 to December 2021. Four type I and two type IV were diagnosed based on the Bryan and Morrey classification. Our patients underwent an open reduction and internal fixation of coronal shear fractures with the use of SmartNail®. Results. All patients were satisfied with the treatment outcome and had full pronation and flexion after surgery. Two patients presented minor deficits of extension and supination compared with the contralateral elbow. At the one-year follow-up, all patients scored 100 on the Mayo Elbow Performance Score. Conclusions. Correct diagnosis and early surgical intervention in humeral capitellum fractures are crucial. That fractures should be anatomically reduced with no articular cartilage damage in order to prevent osteoarthritis. Based on our experience, SmartNail® implant is accurate for the osteochondral fragment fixation

Paediatric flatfoot

Stopa płasko-koślawa u dzieci stanowi poważny problem terapeutyczny. W trakcie rozwoju dziecka stopa podlega procesom modyfikacji cech anatomicznych i fizjologicznych. U małych dzieci stopa płasko-koślawa jest wariantem fizjologicznym. Oceny deformacji stopy płasko-koślawej dokonuje się na podstawie badania klinicznego, badania na podoskopie i ewentualnie badania radiologicznego. Dopiero od wieku około 3 lat wymagane jest rozważenie wdrożenia leczenia, początkowo zachowawczego, z zastosowaniem rehabilitacji i ewentualnie wkładek ortopedycznych. Niektórzy pacjenci ze względu na występujące dolegliwości bólowe, szczególnie tyłostopia, wymagają leczenia z wykorzystaniem leków przeciwbólowych, przeciwzapalnych lub także fizykoterapii. Brak postępu w leczeniu zachowawczym wymaga rozważenia wdrożenia leczenia operacyjnego, które musi być indywidualnie dopasowane do pacjenta. Najczęściej stosowanym zabiegiem jest artroereza stawu skokowo-piętowego, połączona opcjonalnie z wydłużeniem ścięgna Achillesa. W utrwalonych deformacjach lub wrodzonych stopach płasko-koślawych wykonuje się także korygujące zabiegi kostne, połączone najczęściej z procedurami na tkankach miękkich

Conservative treatment and outcome of upper cervical spine fractures in young children: A STROBE-compliant case series.

Cervical spine (C-spine) fractures in young children are very rare, and little information on treatment modalities and functional, radiographic, and patient-reported outcome exists. In this 2-center, retrospective case series, we assessed subjective and functional mid-term outcomes in children aged ≤5 years whose C-spine fractures were treated nonoperatively.Between 2000 and 2018, 6 children (median age at injury: 23.5 months; range: 16-31 months) with C1 or C2 injuries were treated with Minerva cast/brace or soft collar brace at 1 of the 2 study centers. Two patients suffered C1 fractures, and 4 patients had lysis of the odontoid synchondrosis. Overall, 3 children had sustained polytrauma. One child died due to the consequences of massive head injury.For the primary outcome parameter, we recorded subjective symptoms such as pain and functional restrictions due to the sequelae of C-spine injuries at follow-up.Based on medical records, we also assessed the causes of injury, diagnostic procedures, treatments and complications, and time to fracture consolidation.Median follow-up of the 5 surviving children was 51 months (range: 36-160 months). At the latest follow-up, 4 of 5 children did not complain of any pain. One child who sustained an open head injury in combination with a subluxation of the odontoid and undisplaced fracture of the massa lateralis reported occasional headache. All patients experienced complete fracture healing and normal range of motion of the cervical spine.Median duration of cast/brace treatment was 8.5 weeks. Fracture healing was confirmed by computed tomography in all patients.All C-spine injuries were managed with either Minerva cast/Halo brace or soft collar brace without complications.In our retrospective case series, nonoperative treatment of atlas fractures and dislocations or subluxations of the odontoid in young children using Minerva casts or prefabricated Halo braces resulted in good subjective and functional outcomes at mid-term. We observed no complications of conservative treatment of C1 and C2 injuries in young children

Evaluation of using the Anderson-Montesano and the Tuli classifications in pediatric patients with occipital condyle fractures

Background: Occipital condyle fractures (OCFs) in patients before 18 years of age are rare. Classifications of OCF are based on the CT images of the cranio-cervical junction (CCJ) and MRI. The Anderson-Montesano and Tuli classifications are the types which are most commonly used in these cases. Classification of OCFs allows the implementation of OCF treatment. The aim of this study was to evaluate the effectiveness of using the OCF classification in pediatric patients based on the analysis of our own cases. Methods: During the years 2013–2020, 6 pediatric patients with OCFs, aged 14–18, have been treated. Two patients with unstable fracture III according to Anderson-Montesano and IIB according to Tuli were treated with the halo-vest. Additionally, one patient presenting neurological symptoms and with an associated C1 fracture was qualified for the halo-vest stabilization as well. The other patients were treated with a Minerva collar. We evaluated the results 6 months after completing the OCF treatment using the Neck Disability Index (NDI) and SF-36 questionnaires. Confidence intervals for the mean values were verified using the MeanCI function (from the R library DescTools) for both classical and bootstrap methods. Results: Based on NDI results, we have obtained in our patients an average of 4.33/45 points (2–11) and 9.62% (4.4–24.4). Based on the SF-36 questionnaire, we obtained an average of 88.62% (47.41–99.44). Conclusion: The Anderson-Montesano and Tuli’s classifications of OCF can be used to assess the stability of OCF in adolescents, but both classifications should be used simultaneously. CT and MR imaging should be used in diagnosing OCFs, whereas CT allows assessing therapeutic outcomes in OCF