Evaluation of the Results of Surgical Treatment and Rehabilitation of Cubital Tunnel Syndrome

The aim of this study was to evaluate the results of surgical treatment and rehabilitation of cubital tunnel syndrome patients. We treated 21 patients with cubital tunnel syndrome, comprising 12 women and 9 men aged 45 to 58. The syndrome affected 13 left and 8 right upper limbs. According to the modified McGowan classification patients experienced varying levels of change: 17 (81%) patients, grade 3; 3patients (14%), - 2B; 1patient (5%), - 2A. The following patients qualified for surgical treatment: those with pain in the medial side of the elbow joint, those with advanced dysaesthesia and weakness in the motor activity of the hand, and those with changes causing subluxation of the ulnar nerve. All patients were treated surgically through anterior transposition if necessary epineurotomy.The rehabilitation process included exercises involving stretching, relaxing and strengthening of muscle and improvement of the mobility of the elbow. Neuromobilisation and automobilisation exercises were conducted. Patients were taught the correct positioning of the upper limb during work and physical activity. After 12 months, the research results were rated according to the modified criteria of Wilson and Krout. In 16 (76.2%) patients the results were excellent; in 16 (19%) good and in 1 (4.8%) fair. It was found that the vast majority of patients with advanced changes caused by cubital tunnel syndrome and subluxation of the ulnar nerve can achieved excellent and good results from decompression and transposition of the ulnar nerve and competent rehabilitation treatment

The Results of Early and Delayed Treatment of Injuries of the Extensor Tendons of the Fingers in Own Material

The aim of this study was to evaluate the results of early and delayed surgical treatment and the rehabilitation of patients with traumatic injury in zone I of the extensor tendon of the fingers II–V. 47 patients after traumatic, closed damage of the extensor tendons of the fingers II–V of the hand were treated and examined. 17 women (36.2%) and 30 men (63.8%) aged 14–80 years were included in the study. Patients with a delayed first degree damage of the extensors tendon, as well as fourth degree damage, according to the Doleyle scale qualified for surgical treatment. Surgical treatment consisted of suturing the tendon band or restoring its attachment to the phalanx bone, as well as the arthrodesis of the distal interphalangeal (DIP) joint with Kirschner wire in extension. The wire was removed after 6 weeks. Rehabilitation treatment was carried out in order to restore a full range of motion of the fingers. Patients were under constant supervision of the medical team. The examination of the patients took place before and 3 months after the surgery. The presence of the pain was assessed by means of a 10-point VAS scale (Visual Analog Scale). A goniometer was used to measure the range of motion of patient’s fingers. Crawford’s scale was used to assess the results of treatment of injuries to the extensor tendons of the fingers. The early stages of treatment to these yielded excellent results in 84.2% of patients, 14.3% good results, 17.8% of satisfactory results and 3.6% of patients had poor results. The differences in the results were not statistically significant. Further operative intervention should be considered for patients with extensive damage to the tendon of the extensor finger with a greater detachment of a fragment of phalanx bone shortly after the injury. In patients with extensive damage to the tendon of the extensor finger with greater detachment of bone fragment of phalanx further surgery in the early period after injury should be considered

The Effect of Hand Rehabilitation Treatment on Patients Operated for Ganglion Cyst of The Wrist in Own Material

The aim of the study was to evaluate the effect of rehabilitation treatment to improve the treatment results of patients operated for ganglions of the wrist. We studied the hands of 77 patients with ganglions of the wrist. 43 women and 34 men aged between 16 and 98 years participated in the study. The open method was used in the surgical treatment to remove the wrist ganglions in all the patients. In the post-operative treatment 46 patients (group I) underwent hand rehabilitation treatment under the supervision of the authors and 31 patients (group II) did not undergo such a treatment. The examination was carried out on all the patients before surgery and at weeks 1 and 4 after surgery. The patients with ganglions of the wrist and pain, impaired hand mobility and impaired hand efficiency were qualified for the surgical treatment. In the rehabilitation treatment stretching exercises were performed as well as loosening and stabilizing the hand and teaching the patients the correct positioning of the upper limb during work and physical activity. The results were statistically analyzed using non-parametric tests such as the chi-square test, signs test and Mann-Whitney test. It was found that in patients after surgical removal of the wrist ganglion rehabilitation treatment has led to the resolution of pain syndromes, movement disorders and efficiency of hand

Influence of Selected Physical Exercises to Improve Outcomes in Patients Operated for Carpal Tunnel Syndrome in Own Material

The purpose of this study was to evaluate the influence of selected physical exercises on the improved results of treatment of patients operated for carpal tunnel syndrome. Hands were examined in 112 patients treated for carpal tunnel syndrome, aged 33 to 80 years. All individuals underwent open surgery procedure. Patients were divided into group I, in which the exercise was carried out under the supervision of the authors of this study and group II, in which exercises were not performed. Measurements were performed on all patients before surgery (initial) and 6 weeks after (final). Symptoms were studied according to Whitley and Mc Donnell, and they included night pain, sensory disturbance, thenar muscle weakness, Tinel’s sign and Phalen’s maneuver, the bottle syndrome and the opponens pollicis muscle activity. In the treatment of enhancing gliding exercise (automobilization) and neuromobilization. Stabilizing exercises included automobilization (nerve gliding) and neuromobilization. Wrist and hand stabilizing exercises were used and the correct settings in the carpo-metacarpal joints during work and physical activity were taught. The results were statistically analyzed using Chi-squared test. It was found that in patients with carpal tunnel syndrome the best way to eliminate or reduce symptoms of hands mobility disorders comes primarily with surgical treatment, followed by rehabilitation treatment using gliding and neuromobilization exercises

Surgical Treatment and Rehabilitation of Trigger Thumb and Finger

The aim of the study was to evaluate the results of surgical treatment and rehabilitation of patients with trigger thumb and finger. In 40 patients, comprising 30 women and 10 men aged 26 to 64, a total of 42 cases of trigger thumb and finger. In the preoperative period, the severity of changes were studied according to the classification developed by Newport et al. Five patients were classified in the first stage, 28 in the second, 6 in the third, and 1 in the fourth. The mean duration of symptoms was five months. The indication for surgery was a lack of improvement following conservative treatment. All of the patients were treated surgically using the open method by cutting the flexor tendon sheath in part A1. The rehabilitation treatment included exercises to improve the range of mobility of the thumb and fingers and to stretch, grelax, and strengthen muscles. Neuromobilisation and automobilisation exercises were conducted. After 5 months, swelling, pain and restricted mobility of the thumb and fingers subsided in all patients. There were no ‘jumping’ symptoms. Apart from a slight transitory inflammatory reaction in 2 patients there were no complications. In patients with trigger finger, open surgery and competent rehabilitation therapy enables the achievement of very good results, with a low complication rate

Effects of Physical Exercise on the Motility of Hands in Patients Operated because of Dupuytren's Contracture in Own Material

The purpose of this study was to evaluate the effect of physical exercise on limited locomotion in the hands of patients who underwent surgery to correct Dupuytren's contracture. We studied the hands of 84 patients with Dupuytren's contracture aged from 30 to 84 years. In all patients, the contracture was removed by performing a partial fasciectomy. Physical exercises were carried out a week prior to surgery and during the postoperative period. Patients were divided into group I, in which the exercise was carried out under the supervision of the authors of this study and group II, in which exercises were performed sporadically and without professional supervision. Measurements were performed on all patients one week before surgery (A), 1 week after surgery (B) and 6 weeks after (C). The range of movement of fingers was measured using a goniometer. The average total loss of finger extension was evaluated, taking due account of the extension loss in the MCP, PIP and DIP joints of all fingers of the treated hand. Rehabilitation treatment included active and passive exercises; in more severe cases the treatment of choice was massage and special equipment to help bear flexion contracture. Test results were statistically analyzed. In all patients, there was an increase in mobility of the fingers. Patients taking part in physical exercise had significantly greater range of finger movement

Impact of Selected Serum Factors on Metastatic Potential of Gastric Cancer Cells

(1) Background: stromal-derived factor-1 (SDF-1/CXCL12), hepatocyte and vascular-endothelial growth factors (HGF and VEGF) have been shown to facilitate cell motility, proliferation and promote local tumor progression and metastatic spread. Recent research shows the important role of these cytokines in gastric cancer (GC) progression. (2) Methods: 21 gastric cancer patients and 19 healthy controls were included in the study. SDF-1, HGF and VEGF levels were evaluated in sera by ELISA. Patients and control sera were used to stimulate CRL-1739 GC cell line, and chemotaxis, adhesion and proliferation potential were assessed. (3) Results: Concentrations of SDF-1, HGF and VEGF were significantly higher in patients than in controls. Chemotaxis and adhesion assays revealed a significant response of GC cells to patients’ serum. Furthermore, significant relationships were seen between chemotactic/adhesion response and tumor stage. Serum from intestinal early GC patients produced significantly stronger chemotactic response when compared to patients with metastatic spread. In turn, serum from patients with distal metastases significantly increased the adhesion of GC cells when compared to sera from the patients with no distal metastases. We also observed that HGF strongly stimulated the proliferation of CRL-1739 cells. (4) Conclusions: We observed that the sera from GC patients, but also SDF-1, HGF and VEGF used alone, have a strong pro-metastatic effect on CRL-1739 cells. We also demonstrated that the concentration of these cytokines is specifically elevated in the sera of patients in an early stage of malignancy. Our results indicate that SDF-1, HGF and VEGF are very important molecules involved in gastric cancer progression

Endoscopic findings in the upper gastrointestinal tract in patients with Crohn’s disease are common, highly specific, and associated with chronic gastritis

Abstract Crohn’s disease (CD) may affect the entire gastrointestinal tract including its upper part. However, this aspect is poorly addressed in scientific literature and considered a rare finding. Here we aimed to prospectively investigate the prevalence, characteristics and clinical significance of upper gastrointestinal tract involvement in patients with CD, with particular focus on stomach bamboo joint-like appearance (BJA), Helicobacter pylori status and presence of microscopic changes. 375 prospectively recruited patients were included. In CD patients the prevalence of gastric and duodenal, but not esophageal, mucosal lesions, such as gastric mucosal inflammation, duodenal edema, ulcerations, and duodenal bulb deformation was significantly higher (at least p < 0.01 for all). Similar results were found when only H. pylori negative individuals were analyzed. Moreover, BJA of the stomach and in case of H. pylori negative patients also duodenal bulb deformation were detected exclusively in CD patients. Presence of BJA lesion was not significantly associated with neither duration of the disease nor use/history of biologic treatment. Despite absence of H. pylori infection microscopic features of chronic gastritis were found in almost all (93.5%) patients, and in 31% of controls (p < 0.00001). Our analysis outlines that upper gastrointestinal tract involvement in CD is a very common event and frequently manifests with a highly specific BJA lesion. Furthermore, our study reveals that in almost all CD patients features of H. pylori negative gastritis are present

Ocena niektórych fizjologicznych efektów zastosowania Nordic Walking jako uzupełniającego elementu ćwiczeń fizycznych w drugim etapie rehabilitacji po zawale serca

Background: Walks and marches are a simple yet effective forms of physical activity, commonly used in the cardiac rehabilitation. It has been recommended recently to combine march training with exercises involving upper limbs. One of the most popular methods is Nordic Walking, during which special poles are used to increase the work of upper part of the body. The aim of the study was to assess the influence of Nordic Walking on the improvement in exercise tolerance and physical performance in patients rehabilitated after a myocardial infarction.Methods: The study population consisted of 30 patients hospitalized in a cardiac rehabilitation ward 14 to 28 days after myocardial infarction. On admission and after completing the rehabilitation program patients performed an exercise test following the modified Bruce protocol, a six-minute walk test and a test assessing physical performance (Fullerton test). 10 subjects were assigned to a control group, which followed a standard training program, and 20 patients to a group which additionally performed a march training using the Nordic Walking method 5 times a week. Each session of the march training lasted 40 minutes and consisted of a 3-kilometer walk interrupted by breaks during which respiratory and stretching exercises were performed. During the march and exercises patients used special poles for Nordic Walking.Results: Exercise tolerance improved in both study groups. However, the increase in the exercise tolerance was greater in the group performing Nordic Walking than in the control group (30% vs. 14%, respectively; P &lt; 0.05). The rate-pressure product during the exercise test increased significantly only in the group performing Nordic Walking (from 18.2 x 103 ± 3.3 x 103 to 20.7 x 103 ± 4.4 x 103; P &lt; 0.05). The improvement in the results of the six-minute walk test was greater in the group performing Nordic Walking (22% in comparison with 17% in the control group; P &lt; 0.05). The results of the test assessing physical performance (Fullerton test) improved in both study groups.Conclusion: The results of this preliminary study indicate that march training using the Nordic Walking method effectively increases exercise tolerance and physical fitness in patients after myocardial infarction. If these findings are confirmed by the results of larger studies, Nordic Walking could be widely used in the early phases of cardiac rehabilitation. The influence of Nordic Walking on the cardiovascular risk factors and quality of life parameters should be investigated.Cel: Spacery i marsze są prostą a jednocześnie efektywną formą aktywności fizycznej powszechnie stosowaną w rehabilitacji kardiologicznej. W ostatnich latach podejmuje się próby urozmaicenia ćwiczeń marszowych poprzez szersze włączenie pracy kończyn górnych, co umożliwia między innymi coraz bardziej popularna forma aktywności ruchowej znana jako Nordic Walking. Celem niniejszej pracy była ocena wpływu marszu nordyckiego na stopień poprawy tolerancji wysiłku oraz sprawność ogólną chorych rehabilitowanych po zawale serca (ZS). Metoda: Badaniom poddano 30 pacjentów, którzy w okresie 14–28 dni po ZS przebywali na Oddziale Rehabilitacji Kardiologicznej. U wszystkich pacjentów włączonych do programu badawczego przed rehabilitacją i po jej zakończeniu wykonano próbę wysiłkową wg zmodyfikowanego protokołu Bruce’a, 6-minutowy test marszowy oraz test sprawności fizycznej „Fullerton”. Chorych podzielono na dwie grupy. 10 pacjentów uczestniczyło w standardowym programie treningowym (grupa K), a u 20 pacjentów zastosowano dodatkowo (5x w tygodniu po 40 min) trening marszowy typu Nordic Walking (grupa NW). Polegał on na przejściu 3 kilometrów z przerwami przeznaczonymi na ćwiczenia oddechowe i rozciągające. W trakcie marszu oraz ćwiczeń z pacjenci wykorzystywali specjalne kije skonstruowane do tej formy aktywności ruchowej Wyniki: W obu grupach trenujących uzyskano poprawę tolerancji wysiłku, jednak odsetek poprawy w grupie NW (30%) był wyższy niż w grupie K (14%). Podobnie zachowywały się wartości iloczynu podwójnego (RPP). Istotne statystycznie zwiększenie RPP po treningu rehabilitacyjnym stwierdzono jedynie w grupie z NW (z 18,2 x 103 ±3,3 x 103 do 20,7 x 103 ±4,4 x 103) (p<0,05). 6-minutowa próba marszowa wykazała wyższy odsetek poprawy w grupie NW (22%) niż w grupie K (17%). Wyniki testu „Fullerton” wykazują istotną statystycznie poprawę analizowanych parametrów w obu grupach. Wnioski: Wstępne badania wskazują na celowość wdrażania marszu nordyckiego do programów rehabilitacji kardiologicznej po zawale serca z uwagi na wysoką efektywność w zakresie wpływu na poprawę tolerancji wysiłku i sprawności fizycznej. Pełne zaadoptowanie Nordic Walking jako jednej z istotnych metod wczesnej rehabilitacji kardiologicznej będzie możliwe po dokonaniu i przeanalizowaniu większej liczby obserwacji poszerzonych o dodatkowe parametry, głównie w zakresie wpływu na czynniki ryzyka oraz parametry jakości życia