Paraneoplastic brainstem encephalomyelitis and atypical form of chronic inflammatory demyelinating polyneuropathy in patient with testicular germinal tumor—Is this an overlap syndrome? A case report

Paraneoplastic neurologic syndromes are diagnosed when neurologic symptoms are associated with neoplasm and other causative factors are excluded. They may precede or be simultaneous to various types of neoplasms, mainly malignant. In men up to 45–50 years old the most common cancer causing the paraneoplastic syndrome is testicle tumor, manifesting usually as limbic/brain stem encephalitis and myelitis. Usually effective treatment of underlying neoplasm brings resolution of neurologic symptoms. But corticosteroids and intravenuous immunoglobulins are also used. In the presented case a 37-year-old man was primarily diagnosed and treated for progressive tetraparesis with signs of both upper and lower motor neuron dysfunction, associated with bulbar symptoms. Having various diagnostic procedures performed an atypical form of chronic inflammatory demyelinating polyradiculoneuronopathy was primarily suspected, but eventually a discovery of endodermal sinus tumor in the testicle enabled to state the diagnosis of possible paraneoplastic syndrome. In spite of chemotherapy the patient died shortly after the diagnosis because of infectious complications. Histopathology displayed intense inflammatory changes in the brain stem as well as in cranial nerves and cervical spinal cord. The same immunological process evoked by various pathogenetic factors (infection vs. neoplasm) may cause similar clinical picture and hinder the diagnosis. Most importantly it may delay the proper way of treatment

Żywienie dojelitowe i pozajelitowe w udarze mózgu — stanowisko Grupy Ekspertów Sekcji Chorób Naczyniowych Polskiego Towarzystwa Neurologicznego

U chorych po udarze mózgu bardzo często występują zaburzenia przyjmowania, wchłaniania i metabolizowania pokarmów. Niedożywienie w znaczącym stopniu zwiększa ryzyko wstąpienia powikłań oraz wpływa na czas hospitalizacji, skuteczność rehabilitacji i jakość życia. W pracy przedstawiono stanowisko Grupy Ekspertów powołanej z inicjatywy Sekcji Chorób Naczyniowych Polskiego Towarzystwa Neurologicznego dotyczące żywienia dojelitowego i pozajelitowego po udarze mózgu

Mechanical thrombectomy in acute stroke – Five years of experience in Poland

Objectives Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a description of 5 years of experience with MT in acute stroke in Comprehensive Stroke Centers (CSCs) in Poland. Methods and results We retrospectively analyzed the results of a structured questionnaire from 23 out of 25 identified CSCs and 22 data sets that include 61 clinical, radiological and outcome measures. Results Most of the CSCs (74%) were founded at University Hospitals and most (65.2%) work round the clock. In 78.3% of them, the working teams are composed of neurologists and neuro-radiologists. All CSCs perform CT and angio-CT before MT. In total 586 patients were subjected to MT and data from 531 of them were analyzed. Mean time laps from stroke onset to groin puncture was 250±99min. 90.3% of the studied patients had MT within 6h from stroke onset; 59.3% of them were treated with IV rt-PA prior to MT; 15.1% had IA rt-PA during MT and 4.7% – emergent stenting of a large vessel. M1 of MCA was occluded in 47.8% of cases. The Solitaire device was used in 53% of cases. Successful recanalization (TICI2b–TICI3) was achieved in 64.6% of cases and 53.4% of patients did not experience hemorrhagic transformation. Clinical improvement on discharge was noticed in 53.7% of cases, futile recanalization – in 30.7%, mRS of 0–2 – in 31.4% and mRS of 6 in 22% of cases. Conclusion Our results can help harmonize standards for MT in Poland according to international guidelines

Methods of physiotherapeutic management used in the treatment of secondary lymphoedema in the Holycross Cancer Centre in Kielce

Lymphoedema is a serious problem in patients treated for malignant neoplasm. The removal of regional lymph nodes – lymphadenectomy – is an inherent consequence of the surgical treatment of malignant neoplasm of breasts, genitals, prostate, skin cancer, salivary glands cancer and many others. The basic methods of conservative treatment of this chronic disease include complex methods of physiotherapy. The aim of this study is to present the rules of rehabilitation of patients treated for lymphoedema, which have been adopted by the team of the Department of Rehabilitation in the Holycross Cancer Centre in Kielce. This paper presents complex methods of physiotherapeutic management and discusses their availability and practical application in Polish health care institutions

The effect of Foundation for Active Rehabilitation camps on the quality of life of individuals with spinal cord injury

Introduction.The consequences of spinal cord damages rank among the most serious dysfunctions of the human musculoskeletal system. In spite of the development of medicine, the effects of treatment and rehabilitation are still insufficient for patients and their families. Purpose. The aim of this study was to determine the effect of the participation of individuals with spinal cord injury in the introductory camps organized by the Foundation for Active Rehabilitation in the subjective sense of quality of life and the meaning of life and the motivation to search for the meaning of life. Material and methods. It involved a group of 100 participants of the introductory camp organized by the Foundation for Active Rehabilitation. These same 100 subjects were then followed up three months after the end of camp. Quality of Life Index Ferrans and Powers; PIL-Test ; SONG-Test. Results. As a result of camp participation of persons with spinal cord injury in the camp, significant increase was observed in the global Quality of Life Index score, health and functioning subscale and psychological/spiritual subscale. As a result of camp attendance, global PIL test score significantly increased, while global SONG test score significantly decreased. Conclusions. Participation by individuals with spinal cord injury in the introductory camps organized by the Foundation for Active Rehabilitation has a positive impact on the subjective quality of life, strengthens sense of the meaning of life and decreases the motivation to find its purpose

Ocena funkcji barku u kobiet po 60. roku życia leczonych z powodu raka piersi

The overall risk of contracting various diseases, including breast cancer, increases with age. An on-going process of population ageing challenges modern physiotherapy with the need to have functional capacity in older people appreciably enhanced. The issue of anthropometric assessment of the range of motion and shoulder muscle strength is presently much underrated in the physical rehabilitation management of women patients after radical one-sided mastectomy. The study aimed to assess the functional mobility of a shoulder expressed as a range of motion, in conjunction with the assessment of shoulder muscle strength, in women patients over 60 years of age after radical one-sided mastectomy. The study comprised 24 patients (mean age 65 years) recruited from the Department of Rehabilitation, Holy Cross Cancer Centre, Kielce. All patients had undergone modifi ed radical mastectomy using the Madden technique, and an adjuvant therapy. The shoulder range of motion, i.e. flexion, abduction, internal and external rotation, was evaluated by a goniometer. Elevation, protraction and retraction movements were evaluated using an anthropometric device. A dynamometer was applied to assess the strength of select muscle groups within the shoulder during elevation, protraction and retraction motions. Statistical analysis was made with the aid of STATISTICA 12.0 software, having adopted a 0.05 alpha level as statistically signifi cant. The movements of fl exion, abduction and external rotation of the upper extremity were signifi cantly reduced on the mastectomy side. The range of motion and muscle strength during shoulder elevation, protraction and retraction were significantly diminished on the operated side (12% - 14%), compared to the non-operated one. 1. Functional mobility of the shoulder was signifi cantly reduced on the mastectomy side. 2. Results of the present study highlight the need to extend the scope of rehabilitation regimens offered to older women after radical one-sided mastectomy.Wstęp: Z wiekiem wzrasta ryzyko zachorowania na różne choroby, w tym raka piersi. Postępujący proces starzenia się społeczeństw wymaga od współczesnej fizjoterapii zwiększenia sprawności funkcjonalnej osób starszych. Problem antropometrycznego pomiaru zakresu ruchu oraz siły mięśni barku jest słabo dostrzegany w procesie usprawniania pacjentek po mastektomii. Cel pracy: Celem badania była ocena funkcji barku wyrażonej w zakresie ruchu i siły mięśniowej u pacjentek po 60. r.ż., po mastektomii. Materiał i metody: Do badania zakwalifikowano 24 pacjentki (średnia wieku: 65 lat) w Zakładzie Rehabilitacji Świętokrzyskiego Centrum Onkologii w Kielcach. Wszystkie pacjentki były poddane zmodyfikowanej radykalnej mastektomii metodą Maddena oraz odpowiedniemu leczeniu uzupełniającemu. W Zakładzie Rehabilitacji zbadano zakres ruchomości stawów ramienno-łopatkowych podczas zgięcia, odwiedzenia, rotacji wewnętrznej oraz rotacji zewnętrznej za pomocą goniometru. Ruchy unoszenia, wysuwania do przodu (protrakcja) oraz cofania (retrakcja) barku oceniano za pomocą antropometru. Dynamometrem zbadano siłę wybranych grup mięśni barku podczas unoszenia, wysuwania do przodu oraz cofania. Analizę statystyczną wykonano za pomocą pakietu STATISTICA 12.0, przyjęto poziom alfa = 0,05. Wyniki: Ruchy zgięcia, odwodzenia i rotacji zewnętrznej kończyny górnej były istotnie statystycznie ograniczone po stronie operowanej piersi. Zakres ruchu oraz siła mięśni barku podczas unoszenia, wysuwania do przodu i cofania były istotnie statystycznie mniejsze po stronie wykonanej mastektomii (12%-14%) w stosunku do strony zdrowej. Wnioski: 1. Funkcja barku u kobiet po 60. roku życia, po stronie operowanej piersi jest znacząco ograniczona. 2. Przedstawione badania wskazują na konieczność poszerzenia zakresu rehabilitacji chorych w starszym wieku po leczeniu raka piersi

Stroke in the form of artery of Percheron syndrome. Case report

The artery of Percheron is a rare anatomical variant in which the medial parts of both thalami and the medial part of mesencephalon are supplied by branches of a common trunk deriving from the proximal section of one of the posterior cerebral arteries. The artery was given its name after her discoverer, who was the first to describe this anatomic variant in 1966. According to his classification in human brain there are four types of arterial supply of thalami and the artery of Percheron is the variant IIb. Pathologic process involving artery of Percheron (in most cases in course of small vessels disease or cardiogenic embolism) may lead to stroke giving typical triad of symptoms: abnormal vertical eye movements, memory and consciousness disturbances. Sudden onset of these symptoms may suggest the basilar artery syndrome, but prognosis in Percheron’s artery syndrome is more favourable. In our paper we present a case of a patient with bilateral thalami stroke probably due to cardiogenic embolism of the artery of Percheron.Tętnica Percherona jest rzadkim wariantem anatomicznym unaczynienia, w którym przyśrodkowe części obu wzgórz i przyśrodkowa część śródmózgowia zaopatrywane są przez odgałęzienia pojedynczego naczynia krwionośnego odchodzącego od jednej z tętnic tylnych mózgu, najczęściej w jej odcinku proksymalnym. Tętnicy tej nadano nazwę jej odkrywcy, który w 1966 roku po raz pierwszy opisał ten wariant anatomiczny. Według opracowanej przez niego klasyfikacji u człowieka istnieją cztery typy unaczynienia wzgórz, a tętnica Percherona stanowi typ IIb. Proces patologiczny w obrębie tętnicy Percherona (najczęściej w przebiegu choroby małych naczyń lub zatorowości kardiogennej) może prowadzić do udaru powodującego triadę charakterystycznych objawów: upośledzenie pionowych ruchów gałek ocznych, zaburzenia pamięci i zaburzenia świadomości. Nagłe pojawienie się wymienionych objawów klinicznych może sugerować udar mózgu w zakresie unaczynienia tętnicy podstawnej, a nie tętnicy Percherona, jednakże rokowanie w tym drugim przypadku jest znacznie lepsze. W niniejszej pracy przedstawiamy przypadek pacjenta z obustronnym udarem niedokrwiennym wzgórz w przebiegu prawdopodobnie zatorowości kardiogennej tętnicy Percherona

The level of knowledge about risk factors for cervical cancer and health-related behaviours of women from the area of the Świętokrzyskie Region

Introduction : In the world cervical cancer is the second most common malignant tumour among women, as well as the second most common cause of death. Most often this disease develops in women who are between 35 and 59 years old, i.e. at the time when many women raise children and are active professionally. There is a close correlation between the incidence of cervical cancer and lifestyle and the risk factors associated with it. Aim of the research : Evaluation of the influence of knowledge about risk factors for cervical cancer on health-related behaviours of women from the area of the Świętokrzyskie Region. Material and methods: The research material was obtained on the basis of a survey. The study was conducted among 108 randomly selected women in the age range 20 to 60 years. Results: Based on the studies, a significant correlation between the women’s health-related behaviours and their age, level of knowledge, and awareness of belonging to the group at risk of cervical cancer was found. Conclusions: Among the respondents, older women showed more incorrect behaviours than younger women. It was also shown that the place of residence did not have an influence on health behaviour of the surveyed women. Respondents who participated in health education showed greater knowledge about the factors of cervical cancer than women not participating in the education. Women who were aware of belonging to the risk group for cervical cancer more often showed health-related behaviours

The role of physical activity in maintaining health after mastectomy

The treatment of breast cancer requires intensive methods. Depending on the severity of the disease surgery, radiotherapy, chemotherapy, or endocrine therapy is applied. In most cases these methods are combined, thus increasing the chances of recovery, but also intensifying side effects. Until recently, physical activity was contraindicated in the treatment of malignant tumours. Currently, an increasing number of studies confirm the beneficial effect of physical activity on the physical and mental state of people after the treatment of malignant tumours. The paper presents selected studies showing the impact of physical activity on the physical fitness of women treated for breast cancer. The authors draw attention to the difficulty of comparing the results of physical activity due to the use of different questionnaires and different methods. Furthermore, the paper includes recommendations on forms of exercise indicated for cancer patients, as well as situations that require restrictions or constitute a contraindication for physical activity