Background.An obstruction of the distal part of the duodenum can occur because of the superior mesenteric artery syndrome (SMAS) after a surgical correction of scoliosis. It is essential to evaluate the risk factors and diagnose the SMAS in time because complications of this condition are life-threatening and it is associated with a high rate of morbidity. Diagnostics of the SMAS is challenging, because it is rare and its symptoms are non-specific. Therefore, in order to better understand the essence of this pathology and to make diagnosis easier we present a rare clinical case of the superior mesenteric artery syndrome after a surgical correction of neuromuscular scoliosis.The clinical case.A 12-year-old girl with a specific development disorder, sensory neuropathy and progressive kypho-scoliosis was admitted to Vilnius University Children’s Hospital. The patient had right side 50-degree thoracic scoliosis and an 80-degree thoracic kyphosis. She underwent posterior spinal fusion with hooks and screws from Th1 to L2. On the fourth day after the surgery the patient developed nausea and began to vomit each day 1-2 times per day, especially after meals. The SMAS was suspected and a nasogastric tube was inserted, stomach decompression and the correction of electrolytes disbalance were made. After the treatment, the symptoms did not recur and a satisfactory correction and balance of the spine were made in coronal and sagittal planes.Conclusions.It is extremely important to identify the risk factors of the SMAS and begin preoperative diet supplements before surgical correction of scoliosis for patients with a low body mass index. After the first episode of vomiting following the surgery, we recommend to investigate these patients for a gastrointestinal obstruction as soon as possible. Decompression of the stomach, enteral or parenteral nutrition, and fluid therapy are essential in treating the SMAS.

Presented here is the case of a nine-month-old boy with the osteomyelitis of the upper area sternum caused by bacillus Calmette-Guerin (BCG), the Danish 1331 strain vaccine against tuberculosis. Upon examination, a swelling of approximately 2×3 cm diameter was observed in the upper sternal area. The mass was hard, fixed and sensitive to palpation with no local skin hyperaemia. Chest X-rays revealed a round mass anterior to the sternum, suggesting a diagnosis of osteomyelitis. A consequent sternal biopsy was performed and Mycobacterium bovis BCG was identified by a positive growth culture.

Spinal deformity surgery is one of the most challenging surgeries that is only performed by highly professional multidisciplinary team in dedicated spinal centres. In the paper, the authors share and present the algorithm for safe and successful management of complex spinal disorders in Vilnius University Hospital Santaros Clinics.

Background. The effectiveness of outpatient mobile laser intervention on specific treatment goals has not been fully explored. Thus, the aim of the study was to examine the effect of orthopaedic knee brace with laser on knee joint function, pain and swelling. Methods. Volunteers were divided into two experimental groups: chronic pain (n = 20, knee pain > 6 months) and acute pain (n = 20, knee pain < 1 week), and one control (n = 20, placebo) group. Subjects in all groups were immobilized in a knee brace for 4 weeks. In addition, the experimental groups underwent low-intensity laser therapy, whereas control group underwent pseudo-laser therapy, every second day for 10 min. The sequences of the tests were as follows: (a) clinical assessments and evaluation of knee extension and flexion amplitude, swelling, Lysholm subjective assessment questionnaire, VAS pain scale, (b) evaluation of balance using Kistler platform, (c) muscle peak torque and isometric torque variability assessment using isokinetic dynamometry. All tests were performed twice - before and after intervention. Results. Knee brace with laser is effective treatment for the reduction of pain, swelling, and recovering of daily functions (p < .05). Operation of the complex device is particularly effective in treating knee pain in the acute period (p < .05). Conclusions. Knee brace with laser therapy in the rehabilitation period ensures faster healing of patients compared to wearing only knee brace, particularly in acute pain, while muscle strength and proprioception remains depressed.

In this article the authors present a method for the backbone recognition and modelling. The process of recognition combines some classical techniques (Hough transformation, GVF snakes) with some new (authors present a method for initial curvature detection, which they call the Falling Ball method). The result enables us to identify high-quality features of the spine and to detect the major deformities of backbone: the intercrestal line, centre sacral vertical line, C7 plumbline; as well as angles: proximal thoracic curve, main thoracic curve, thoracolumbar/lumbar. These features are used for measure in adolescent idiopathic scoliosis, especially in the case of treatment. Input data are just radiographic images, meet in everyday practice.