Endoprotezy stawów biodrowych wczoraj i dziś

Endoprotezoplastyka stawu biodrowego jest w XXI wieku złotym standardem leczenia zaawansowanych zmian destrukcyjnych stawów biodrowych w przebiegu wielu jednostek chorobowych. Co czwarta osoba w starszym wieku będzie miała objawy choroby zwyrodnieniowej stawu biodrowego w trakcie swojego życia, a co dziesiąta przejdzie operację całkowitej endoprotezoplastyki tego stawu. Początki leczenia za pomocą alloplastyki stawu biodrowego sięgają XIX wieku, lecz główny rozwój tego sposobu leczenia to poprzednie stulecie. Wielcy mistrzowie chirurgii jak sir John Charnley, Austin Moore czy Peter Ring inspirują kolejne pokolenia ortopedów do udoskonalania leczenia sposobem alloplastyki i pozwalają przywracać sprawność osobom, które w skutek procesu chorobowego zapomniały, jak można poruszać się swobodnie i bez dolegliwości bólowych. Forum Reumatol. 2017, tom 3, nr 4: 216–221

Jak przygotować chorego z chorobą reumatyczną do alloplastyki stawu kolanowego i/lub biodrowego? Ryzyko wystąpienia okołooperacyjnego zakażenia okołoprotezowego

Każdego roku coraz więcej osób z chorobami reumatycznymi jest kwalifikowanych do całkowitej alloplastyki stawu biodrowego i/lub kolanowego. Przygotowanie chorego do operacji jest trudne nie tylko dla ortopedy, ale może budzić również wątpliwości wśród lekarzy innych specjalności. Mnogość leków stosowanych w reumatologii, ich długotrwałe działanie immunosupresyjne może istotnie wpływać na c zęstość powikłań w okresie okołooperacyjnym. Częstym i bardzo trudnym w leczeniu powikłaniem po endoprotezoplastyce stawów są zakażenia okołoprotezowe. Właściwe okołooperacyjne przygotowanie chorego pomaga zmniejszyć ryzyko infekcji. Kluczowe jest szybkie zdiagnozowanie problemu i wdrożenie właściwego leczenia do 3 tygodni od pierwotnego zabiegu operacyjnego. Opóźnione lub niewłaściwe leczenie zajmuje wiele tygodni i ma mniejsze szanse powodzenia. Forum Reumatol. 2018, tom 4, nr 3: 163–16

Influence of selected demographic factors on traumas in persons over 65 years of age reporting to the Hospital Medical Ward

Background. Falls and traumas in elderly persons don’t only result in health problems, but they also involve social and economic, psychological and political consequences. The most frequent trauma mechanisms in the elderly include: falls and traffic accidents. ;b:Objectives. The aim of the study was to assess selected factors influencing the energy, type and area of a trauma incurred by elderly people. Material and methods. A group of 108 patients aged 65–93 treated at the SPSK 1 in Szczecin were tested by a diagnostic survey with the use of a questionnaire. The eligibility criteria included a trauma as a result of an accident, the age of the subject above 65 years of age and expressing written, voluntary and informed consent to participation in the study. Results. 177 traumas were recorded in the analysed group of 108 patients. The most frequent traumas included fractures and contusions and the lower limbs and the left arm were the most frequently injured body parts. Men were more often injured during low-energy events. Patients more often had their upper body and left leg injured during low-energy events than during high-energy ones. In persons over 65 years of age, usually one fracture occurred during a low-energy accident. Conclusions. The most common result of injuries among people aged 65+ admitted to the emergency department are fractures. With age the number of LE T increases and the number of HET decreases. It’s necessary therefore to create an appropriate health policy covering education for elderly people and their families to prevent injuries of low energy content

Perioperative factors influencing the mortalit

WSTĘP: Tętniaki aorty brzusznej są uznaną przyczyną zwiększonej śmiertelności w populacji europejskiej. Dlatego ważna jest identyfikacja śródoperacyjnych czynników ryzyka zgonu w okresie okołooperacyjnym. MATERIAŁ I METODY: Prospektywnym badaniem obserwacyjnym, przeprowadzonym w Klinice Chirurgii Naczyniowej Pomorskiego Uniwersytetu Medycznego w Szczecinie, objęto grupę 95 pacjentów z tętniakiem aorty brzusznej w odcinku podnerkowym. Na podstawie kryteriów TASC pacjentów zakwalifikowano do implantacji protezy naczyniowej. Analizowano wpływ czynników hemodynamicznych i metabolicznych na śmiertelność okołooperacyjną. Obserwację badanej populacji prowadzono przez 28 dni. WYNIKI: Wykazano, że wzrost stężenia mleczanów, potasu oraz spadek wartości pH szczególnie w pierwszych minutach po odklemowaniu aorty były zasadniczymi czynnikami zwiększającymi śmiertelność w okresie okołooperacyjnym. Ponadto ryzyko zgonu było zwiększone, jeśli poza znieczuleniem ogólnym nie zastosowano znieczulenia regionalnego. Poza tym nie wykazano istotnego wpływu pozostałych badanych czynników. WNIOSKI: Zastosowanie znieczulenia zewnątrzoponowego u pacjentów poddawanych operacjom tętniaków aorty brzusznej jest istotnym, niezależnym czynnikiem zmniejszającym śmiertelność we wczesnym okresie pooperacyjnym. Natomiast zmniejszenie wartości pH, wzrost stężenia potasu i mleczanów w pierwszych minutach po odklemowaniu aorty może być przydatnym wskaźnikiem służącym do identyfikacji pacjentów zagrożonych zwiększonym ryzykiem zgonu we wczesnym okresie pooperacyjnym.INTRODUCTION: Abdominal aorta aneurysm is a recognized cause of death for the European population. The identification of intra-operative risk factors for perioperative death is of crucial importance for the society. MATERIAL AND METHODS: A prospective observational study was conducted in the Vascular Surgery Department of the Pomeranian Medical University in Szczecin, Poland. The study group consisted of 95 patients, diagnosed with abdominal aorta aneurysm in the sub-renal region scheduled for an operative procedure of straight vascular graft implantation. Patient qualification was fulfilled according to TASC criteria. The influence of preoperative factors, hemodynamic and metabolic parameters on the risk of death in the study population was analyzed. Postoperatively, observation was continued for 28 days. RESULTS: In this study group an increase of lactate, potassium levels or pH decrease during the first minute post cross-clamp release were significant risk factors for perioperative death. The importance of metabolic parameters is a recognized risk factor, however their statistical significance within the first minute post cross-clamp release is in our opinion of crucial importance. Additionally, significantly higher mortality was reported among patients without epidural anaesthesia. No importance of other analyzed parameters was found. CONCLUSIONS: Epidural anaesthesia is an independent factor decreasing mortality in the early postoperative period in patients undergoing abdominal aorta aneurysm repair. A decrease of pH value and increase of lactate and K+ levels within the first minute after aortic cross-clamp release may be a valuable tool in identifying patients with an increased risk of perioperative death after abdominal aorta prosthesis implantation

Zalecenia dotyczące postępowania diagnostyczno-terapeutycznego u chorych na pierwotne nowotwory złośliwe kości

Mięsaki kości u dorosłych stanowią heterogenną grupę bardzo rzadkich nowotworów pochodzenia mezenchymalnego (poniżej 0,5% nowotworów złośliwych u dorosłych). Prawidłowe rozpoznanie i skuteczne leczenie skojarzone pierwotnych nowotworów kości są sumą współpracy radiologów, chirurgów onkologów i chirurgów ortopedów, onkologów klinicznych, radioterapeutów, rehabilitantów, patologów, specjalistów medycyny nuklearnej i biologów molekularnych. Bezwzględnym warunkiem w diagnostyce i leczeniu pierwotnych nowotworów złośliwych kości jest wielodyscyplinarna współpraca wielospecjalistyczna w doświadczonych ośrodkach. Polepszenie diagnostyki mięsaków kości, wprowadzenie zasad terapii skojarzonej i postęp technologiczny spowodowały rozszerzenie wskazań do stosowania operacji oszczędzających kończynę oraz poprawiły odległe wyniki leczenia

The Comparison of Sharps Injuries Reported by Doctors Versus Nurses from Surgical Wards in the Context of the Prevalence of HBV, HCV and HIV Infections

The aim of the study was to evaluate the nature and frequency of sharps injuries among doctors and nurses from the same surgical/gynecological wards and the prevalence of HBV/HCV/HIV infection.Material and methods. An anonymous cross-sectional sero-survey, with ELISA system used to detect anti-HBc, anti-HCV, anti-HIV, was conducted among 89 doctors and 414 nurses from 16 randomly selected hospitals in West Pomerania, Poland, between January-June 2009.Results. During the preceding 12 months, 82% doctors and 44.4% nurses (p0.28; anti-HCV - in 1.1% of doctors vs 1.4% of nurses, p>0.79; no anti-HIV positive cases were found. The analysis of potential risk factors for contracting a HBV revealed that for both job categories only length of employment was associated with an increased odds of being infected.Conclusions. Although the prevalence of HBV/HCV infection between doctors and nurses does not differ significantly, modifiable risk factors for contracting a BBI such as frequency and nature of sharps injuries may differ, which call for tailoring preventive measures to specific job categories. Long lasting exposure to injury events should be taken into consideration while assessing the risk for accuiring an occupational infection with HBV, HCV or HIV

Condition Assessment of HV Bushings with Solid Insulation based on the SVM and the FDS Methods

This paper presents the dielectric response of the insulation of bushings as an effect of the simulated long-term aging process. The experiment was conducted under a condition of a high temperature difference between the current circuit and the cover. The dielectric response was measured with the FDS (Frequency Dielectric Spectroscopy) and the SVM (Step Voltage Measurement) methods. The research has shown the correlation between the aging time and some parameters obtained with the FDS and SVM analysis

Influence of selected demographic factors on traumas in persons over 65 years of age reporting to the Hospital Medical Ward

Background. Falls and traumas in elderly persons don’t only result in health problems, but they also involve social and economic, psychological and political consequences. The most frequent trauma mechanisms in the elderly include: falls and traffic accidents. ;b:Objectives. The aim of the study was to assess selected factors influencing the energy, type and area of a trauma incurred by elderly people. Material and methods. A group of 108 patients aged 65–93 treated at the SPSK 1 in Szczecin were tested by a diagnostic survey with the use of a questionnaire. The eligibility criteria included a trauma as a result of an accident, the age of the subject above 65 years of age and expressing written, voluntary and informed consent to participation in the study. Results. 177 traumas were recorded in the analysed group of 108 patients. The most frequent traumas included fractures and contusions and the lower limbs and the left arm were the most frequently injured body parts. Men were more often injured during low-energy events. Patients more often had their upper body and left leg injured during low-energy events than during high-energy ones. In persons over 65 years of age, usually one fracture occurred during a low-energy accident. Conclusions. The most common result of injuries among people aged 65+ admitted to the emergency department are fractures. With age the number of LE T increases and the number of HET decreases. It’s necessary therefore to create an appropriate health policy covering education for elderly people and their families to prevent injuries of low energy content

High Levels of Thromboxane (TX) Are Associated with the Sex-Dependent Non-Dipping Phenomenon in Ischemic Stroke Patients

Background: Inflammation and high blood pressure (nondipping profile) during the rest/sleep period have been associated with an effect on the incidence of cardiovascular disorders and a more severe course in the ischemic cerebrovascular event. There are no available data on the relationship between dipping status and the pro-inflammatory metabolites of arachidonic acid (AA); therefore, we undertook a study to investigate the influence of thromboxane on the incidence of nondipping among patients after stroke. Methods: Sixty-two patients with ischemic stroke (including 34 women and 28 men) were tested for the involvement of thromboxane in the nondipping phenomenon. Subjects were analyzed for the presence of the physiological phenomenon of dipping (DIP group) versus its absence—nondipping (NDIP group). Thromboxane (TX) measurements were performed using liquid chromatography, and blood pressure was measured 24 h a day in all subjects. Results: The analysis of the thromboxane level in the plasma of patients after ischemic stroke showed significant differences in terms of sex (p = 0.0004). Among women in both groups, the concentration of TX was high, while similar levels were observed in the group of men from the NDIP group. However, when comparing men in the DIP and NDIP groups, a lower TX level was noticeable in the DIP group. Conclusions: A higher level of TX may be associated with a disturbance of the physiological phenomenon of DIP in men and women. However, in our opinion, TX is not the main determinant of the DIP phenomenon and, at the same time, other pro-inflammatory factors may also be involved in the occurrence of this singularity