Changes in spino-pelvic alignment after surgical treatment of isthmic spondylolisthesis

Background and purpose To analyze the changes in spino-pelvic parameters after surgical treatment of lumbar isthmic spondylolisthesis. Materials and methods Sixty patients recruited from a group of consecutive series of 128 cases with isthmic spondylolisthesis operated on between 2002 and 2012 in the Department of Neurosurgery, Tarnow, Poland. All patients were operated on by the same surgeon (the first author). Spino-pelvic parameters: PI, SS, PT, LSA, and LL were measured manually on standing lateral view radiograms. Patients were divided according to Spinal Deformity Study Group classification which we modified for means of analysis: (A) low-grade group: subgroups with balanced pelvis and unbalanced pelvis (instead of normal and high PI subgroups), (B) high-grade group: subgroups with balanced and unbalanced pelvis. Results Twenty-nine patients had unbalanced pelvis before the operation. In 10 of them (34%), the procedure resulted in full correction of pelvis position meaning that they achieved balanced pelvis after the surgery. There were 6 patients with low-grade slip who had balanced pelvis preoperatively but showed unbalanced pelvis after the surgery but this loss of balanced pelvis did not affect the clinical outcome which overall was good among them. Patients with unbalanced pelvis presented changes towards restoration of spino-sacro-pelvic anatomy postoperatively: PT decreased while SS increased, although these changes were not statistically significant. Conclusion Further studies are needed to confirm whether surgical correction of spino-pelvic parameters results in better clinical outcome in patients with isthmic spondylolisthesis

Testy prowokacyjne stosowane w diagnostyce zespołu cieśni nadgarstka

The carpal tunnel syndrome (CTS) is the most often diagnosed compressive neuropathy of the upper limb. As a result of the changes within the tunnel of the median nerve, the disease is associated with hypersensitivity to some external factors such as: an increase in pressure within the carpal tunnel, direct or indirect pressure on the wrist level, hypoxia. These factors are used in provocative tests. The aim of this article is to make a distinction between functional test’s classifications used in the CTS diagnosis, depending on the method of ailment provocation. Different modifications used in common tests and their average sensitivity and specificity are also presented. Carpal tunnel syndrome should be diagnosed clinically; although electro-diagnostic studies are a standard method of establishing the diagnosis, they do have limitations. Clinical diagnostic skill must be reinforced by a valuable provocative test: the Provocative Test, the Phalen test + mCCT, Tinel’s sign, Phalen’s and reverse Phalen’s test, Durkan Carpal Compression Test (mCCT). There are also tests, which, due to their low sensitivity and specificity, be not applied in the CTS diagnostics. Provocative tests are more easily performed than electro-diagnostic studies and are the most appropriate diagnostic tools in the ambulatory setting. Provocative tests are commonly needed for establishing the diagnosis for treatment, screening and determining aetiology. To improve the efficiency of provocative tests, we should apply univocal standards for their performance and interpretation. A combination of tests might be more powerful than a single test in establishing the diagnosis. Taking medical history and performing physical examination should be the primary methods of diagnosing CTS. The combination of hand diagram, questionnaires, abnormal sensibility and positive provocative tests will provide a diagnostic tool for CTS with high sensitivity and specificity. The addition of nerve conduction studies is unnecessary in most cases

Testy diagnostyczne stosowane w rozpoznawaniu zespołu kanału nadgarstka

In 1854 Paget described for the first time that carpal tunnel syndrome (CTS) results from compression of the median nerve within the carpal tunnel. CTS predominantly involves tingling and numbness in the typical median nerve distribution. Pain, described as deep, aching, or throbbing, occurs diffusely in the hand and radiates up the forearm. Atrophy of the muscles of the thenar is usually seen later in the course of the nerve compression. CTS is most frequent among persons between the ages of 30 to 60 and is two to three times more common in women than in men (peak prevalence in women older than 55 years). Carpal tunnel syndrome may affect 1% to 10% of the population. Incorrect diagnosis of CTS has been identified as one of the most common causes of CTS treatment failure. CTS should be diagnosed clinically. Electro-diagnostic studies are a standard method of establishing the diagnosis. Electrodiagnostic studies are performed to confirm the clinical diagnosis, to assess the severity of median nerve compression and to rule out more proximal compression sites. Abnormalities in nerve conduction study results can be the only objective evidence of carpal tunnel syndrome. Lack of objective data, such as ENG can lead to incorrect diagnosis and inappropriate treatment. Clinical diagnosis should be reinforced by valuable diagnostic tests: the Semmes–Weinstein monofilaments test – performed in neutral and Phalen’s positions, vibration threshold measured by means of tuning forks or a vibrometer, by observation of thenar atrophy and using provocative tests. The use of common, sensitive and specific diagnostic tests should improve decision making about patients referral for specific therapies, facilitate the performance of epidemiologic studies, increase the accuracy of diagnosis. The combination of a results obtained using various methods might be more powerful than a single test in establishing the diagnosis of CTS. The combination of hand diagram, questionnaires, abnormal sensibility, thenar weakness or thenar atrophy and positive provocative tests constitutes a sensitive and specific diagnostic tool to establish the diagnosis of CTS. Standardized clinical criteria for CTS would be an important step in reducing inconsistencies and misdiagnoses

Ocena czułości testów prowokacyjnych stosowanych w diagnostyce zespołu kanału nadgarstka w zależności od stopnia nasilenia dolegliwości

Background: Using popular provocative tests to diagnose the carpal tunnel syndrome (CTS) facilitates referring patients for specialist treatment and is indispensable to the performance of epidemiologic studies. Patients with severe carpal tunnel syndrome (CTS) are frequently referred for surgery, whereas people with mild CTS are commonly referred for conservative therapy. Finding out which provocative tests are most effective in diagnosing mild cases can aid clinicians in making decisions about further treatment.Objectives: The purpose of this study was to evaluate the sensitivity of provocative tests used for diagnosis of CTS such as Phalen’s, Durkan’s and Tinel’s sign and to find out if the time of paresthesia occurrence during the tests depended on the severity of the syndrome assessed using Levine’s Questionnaire.Material and methods: The study involved 130 women and 33 men with carpal tunnel syndrome confirmed by ENG. 52 patients had bilateral symptoms so a total number of cases examined was 215. Subjects were tested using four CTS provocative tests in random order: Phalen’s, Durkan’s, Provocative and Tinel’s sign. The examiner waited 2 – 3 minutes between each provocative test to ensure that any nerve irritation caused by previous test had abated. Severity level of CTS was assessed using Levine’s Questionnaire .Results: Sensitivity values were: for Phalen’s Test – 85.6%, Durkan’s Test – 86.5%, Provocative Test 84.6%, and Tinel’s sign – 46%. Sensitivity values for Phalen’s, Durkan’s and Provocative tests are higher than 93,1% for moderate, severe and extreme CTS. There is a relationship between testing positive on CTS provocative tests and severity of clinical symptoms. As the severity of CTS increases, the average time of paresthesia occurrence in median nerve distribution decreases. Conclusions: (1) Tinel’s sign should not be recommended as a CTS diagnostic tool because of its low sensitivity. (2) If Levine’s Questionnaire reveals small progression of CTS the sensitivity of the tests is insufficient to confirm CTS. (3) In the case of patients with moderate, severe or extreme CTS according to Levine’s Questionnaire, the diagnosis can be confirmed using valid provocative tests such as Phalen’s, Durkan’s and Provocative

Ocena stopnia nasilenia dolegliwości subiektywnych towarzyszących zespołowi kanału nadgarstka w zależności od nasilenia zmian stwierdzanych badaniem elektroneurograficznym

Introduction: Carpal tunnel syndrome (CTS) is an increasingly widespread pathology occurring in patients from the age of 30 to 60. This illness is 2 to 3 times more common in women.Aim of the study: verification of whether there exists a dependence between the degree of CTS intensification evaluated on the basis of ENG testing and the patients’ clinical state evaluated as an intensification of subjective discomfort and functional ability.Materials and methods: 161 patients were tested (128 women and 33 men) who were being treated for CTS at a hospital clinic and a neurosurgical ward. In 49 patients the symptoms were bilateral in nature hence the combined number of all the tested cases was 210. The age of the patients at the moment of testing was from 25 to 81, the average being 55,2. The severity of CTS was evaluated by means of ENG testing while the intensification of the clinical symptoms was defined as the number of points obtained via the Levin questionnaire (the scale of symptoms SSS (Severity Status Scale) + the functional state scale FSS) as well by means of the VAS scale. Results: Patients with severe CTS obtained on average higher results in the full Levin questionnaire when compared to the group of patients with mild CTS. Through the aid of SSS significant statistical differences were shown in the intensification of subjective symptoms between a moderate and severe degree of CTS. The testing of symptom intensification of pain and/or numbness through the help of the VAS scale showed significant differences between the groups with mild and severe degrees of CTS as well as between the groups with moderate and severe.Conclusions: The result obtained through the help of the Levin questionnaire (BQ) as well as the result of self evaluation of pain and/or numbness through the VAS scale can reflect the degree of damage to the median nerve only in relation to CTS patients with severe disturbances in the ENG test.Wprowadzenia: Zespól kanału nadgarstka (ZKN) jest coraz częściej rozpoznawaną patologia występującą najczęściej u pacjentów pomiędzy 30-60 rokiem życia. Schorzenie to 2 do 3 razy częściej dotyczy kobiet. Cel: Sprawdzenie czy istnieje zaleSność pomiędzy stopniem nasilenia ZKN ocenianym na podstawie wyniku badania ENG a ich stanem klinicznym ocenianym jako nasilenie dolegliwości subiektywnych i sprawność funkcjonalna. Materiał i metoda: Zbadano 161 chorych (12S kobiet i 33 mężczyzn) leczonych z powodu ZKN w poradni przyszpitalnej i na oddziale neurochirurgicznym. U 49 chorych występujące objaw}' miały charakter obustronny, tak więc łączna ilość wszystkich zbadanych przypadków wyniosła 210. Wiek chorych w chwili badania wynosił od 25 do 81 lat, średnio 55,2 lat. Ciężkość ZKN oceniono przy pomocy badania ENG a nasilenie objawów klinicznych określono jako ilość punktów uzyskaną przy pomocy kwestionariusza Levina (skala nasilenia objawów SSS + skala stanu funkcjonalnego FSS) oraz przy pomocy skali VAS. Wyniki: Pacjenci z ciężkim ZKN uzyskują średnio wyższe wyniki w pełnym kwestionariuszu Levina w porównaniu z grupa chorych z łagodnym ZKN. Przy pomocy skali SSS wskazano istotne statystycznie różnice nasilenia objawów subiektywnych pomiędzy umiarkowanym i ciężkim stopniem ZKN. Badanie nasilenia objawów bólu i/lub zdrętwienia przy pomocy skali VAS wykazało istotne różnice pomiędzy grupami o lekkim i ciężkim oraz grupami o umiarkowanym i ciężkim stopniu ZKN. Wnioski: Wynik uzyskany przy pomocy kwestionariusza według Levina (BQ) oraz wynik samooceny bólu i/lub zdrętwienia przy pomocy skali VAS może odzwierciedlać stopień uszkodzenia nerwu pośrodkowego jedynie w odniesieniu do chorych z ZKN z ciężkimi zaburzeniami w badaniu ENG

A retrospective analysis on safety and effectiveness of hypofractioned post-mastectomy radiotherapy

© 2019 Wiley Periodicals, Inc. The data supporting hypofractionated post-mastectomy radiotherapy is limited. The purpose of this study is to present the experience from Tarnów of hypofractionated PMRT over 20 fractions with respect to toxicity and effectiveness. We delivered post-mastectomy radiotherapy at the dose of 45 Gy in 20 fractions to the chest wall and the draining regional lymph nodes. The primary outcome of interest was to ensure that the rate of grade 3 or greater toxicity from the hypofractionation, at any time point, was non-inferior to standard post-mastectomy radiotherapy. We conducted a retrospective analysis of 211 women with stages I-IV breast cancer. After a median follow-up of 30 months, there were four reported grade 3 toxicities, with grade 3 lymphedema being the most frequent (1.5%). There were 134 reported grade 2 toxicities, with grade 2 fatigue being the most frequent (18%). There were six instances of isolated locoregional (6 of 211; 2.8%). Three-year estimated local recurrence-free survival was 96.4% (95% CI 0.921-0.984). The 3-year estimated distant recurrence-free survival was 77.8% (95% CI 0.699-0.838). To our knowledge, the results presented here are the largest single institution experience of hypofractionated post-mastectomy radiotherapy published in the literature to date. Our fractionation scheme, 45 Gy in 20 fractions, seems to be safe and effective with low toxicity

Comparing the outcome of nervous-muscular agitation before and after carpal tunnel release

Wstęp. Najskuteczniejszą formą leczenia ZKN jest zabieg operacyjny. Daje on pacjentowi natychmiastową i, co najważniejsze, długotrwałą poprawę, a nawet całkowite ustąpienie charakterystycznych i uciążliwych objawów towarzyszących temu zespołowi. Jedną z metod pozwalającą na monitorowanie przebiegu procesu reinerwacji i rehabilitacji po urazach nerwów obwodowych jest wykreślenie krzywej i/t. Celem pracy była próba odpowiedzi na pytanie czy krzywa i/t jest wystarczająco czułą metodą do oceny zmian pobudliwości nerwowo-mięśniowej u pacjentów leczonych z powodu z ZKN? Materiał i metoda badań. Badaniami objęto 88 chorych (107 rąk): 70 kobiet (86 rąk) i 18 mężczyzn (21 rąk) w wieku pomiędzy 25 a 77 rokiem życia (średnio 54,4 lata). Wyniki. Leczenie operacyjne połączone z wczesną pooperacyjną rehabilitacją dało statystycznie znamienną poprawę: subiektywnej oceny nasilenia dolegliwości, stanu funkcjonalnego ręki oraz wartości parametrów elektrodiagnostycznych, tj. natężenia prądu dla impulsów trójkątnych o czasie trwania 100 ms, chronaksji, ilorazu akomodacji. Wnioski. Zmiany kształtu krzywej i/t u pacjentów z ZKN poddanych leczeniu operacyjnemu są nieznaczne. Zmiany kształtu krzywej i/t są związane ze zmianami tylko dwóch parametrów: chronaksji oraz natężenia prądu ocenianego dla impulsów trójkątnych o czasie trwania 100 ms. Iloraz akomodacji jest przydatnym parametrem, który może posłużyć do „uchwycenia” zmian pobudliwości nerwowo-mięśniowej po zastosowanym leczeniu. U pacjentów z łagodnym ZKN istnieje potrzeba rozszerzenia schematu badania o ocenę pobudliwości czuciowej. Istnieje wysoka korelacja pomiędzy zmianami wartości ilorazu akomodacji a subiektywnymi zmianami stanu funkcjonalnego u pacjentów z ciężkim ZKN.Introduction. According to literature surgical decompression is believed the most effective aspect of the management of carpal tunnel syndrome. It results in immediate relief of strenuous symptoms of this entity. This in turn enables operated patients return to normal functioning including everyday life and occupational activity. Material and method. The aim of this article is comparing the outcome of nervous – muscular agitation before and after carpal tunnel release obtained through the use of the i/t curve. The study group included 88 patients (107 upper limbs): 70 females (86 hands) and 18 males (21 hands) aged 25 to 77 years (average 54,4 years). Results. Statistically significant improvement was noted in following clinical aspects of CTS: subjective complaints (Levine scores), functional dexterity of affected hand (Levine scores), value of nervous – muscular agitation obtained through the use of the triangular impulse timp 100 ms, chronotaxy, accommodation quotient. Conclusion. Changes in the shape of the i/t curve in patients with CTS after surgical treatment are slight. Differences between pre and postoperative treatment are present in the values of nervous – muscular agitation obtained through the use of the triangular impulse timp 100 ms and chronaxy. Accommodation quotient is a valuable parameter which can be used to ‘record’ changes in neuromuscular excitation after applied treatment. The extension of the test using the i/t curve to include the analysis of sensor excitability can help especially in patient with mild CTS. There are high correlation among changes of value of accommodation quotient and the subjective changes of functional state at patients with severe carpal tunnel syndrome

Quality of life assessment of oncologically treated patients because of breast cancer

Introduction: Currently, in the world, breast cancer is recognized as one in four malignant neoplasms in women. It is the second most common cause of death in cancer patients. The disease, which is a threat to women’s lives, leads to the loss of personal control, during its duration it becomes everyday life with negative emotions such as uncertainty, anxiety and anxiety. Women have contact with a range of negative effects that the disease provides, causing them to resign and destructive to the psychophysical sphere. Disorders in the physical and mental aspect of body image, side effects of therapy, sexual relations with a partner and anxiety about health in the future are factors that have a huge impact on the quality of life of patients. The aim of the study was to assess the quality of life of women with breast cancer. Materials and methods: The quality of life of 40 women with breast cancer who underwent oncological treatment was assessed using the author’s questionnaire with 12 questions and QLQ-BR23 questionnaire with 23 questions.. Results and conclusions: Studies have shown that the biggest problem for women was the side effects of the treatment and the most common discomfort during radiation therapy. They are characterized by redness of the skin, general weakness and fatigue, which in turn later translated into, a change in the perception of their body image, a decrease in their attractiveness, a sense of comfort and confidence. The obtained results showed that the lowest quality of life of the respondents was registered in the domain determining future perspectives. The best result was recorded in the domain of sexual pleasure and sexual functioning. When assessing the quality of life of the respondents, it follows that patients with vocational education have a worse quality of life within the domain of breast symptoms. Employed persons surveyed obtained worse quality of life results in terms of sexual functioning and sexual pleasure. Considering the duration of illness of the respondents, there were no statistically significant differences affecting the quality of life.Wstęp: Obecnie na świecie rak piersi rozpoznawany jest jako co czwarty złośliwy nowotwór u kobiet. Jest on drugą pod względem częstości przyczyną zgonu kobiet chorujących na nowotwór. Choroba często prowadzi do utraty osobistej kontroli. Codziennością staje się obcowanie z negatywnymi emocjami, takimi jak niepewność, niepokój oraz lęk. Kobiety borykają się z całym wachlarzem negatywnych konsekwencji choroby, które są przyczyną rezygnacji oraz działają destrukcyjnie na sferę psychofizyczną. Celem pracy była ocena jakości życia kobiet z rakiem piersi poddanych leczeniu onkologicznemu. Materiał i metody: Ocenie poddano 40 kobiet z rozpoznanym rakiem piersi poddanych leczeniu onkologicznemu w oddziale radioterapii. Do oceny jakości życia zastosowano autorską ankietę oraz kwestionariusz QLQ-BR23. Wyniki i wnioski: Uzyskane wyniki pokazały, że najniższą jakość życia respondentek zarejestrowano w domenie określającej perspektywy na przyszłość. Najlepszy wynik zaobserwowano w zakresie domeny odnoszącej się do przyjemności seksualnej i funkcjonowania seksualnego. Badaniami potwierdzono, że pacjentki z wykształceniem zawodowym wskazały na gorszą jakość życia w obrębie domeny obrazującej objawy ze strony piersi. Pacjentki pracujące zawodowo uzyskały gorsze wyniki jakości życia w zakresie funkcji seksualnych i przyjemności z seksu. Nie zaobserwowano istotnych statystycznie różnic pomiędzy czasem trwania choroby respondentek, a jakością życia

Comparison of the results of sensor and nervous – muscular agitation of the median nerve odtained throught the use of the i/t curve

Wstęp. Krzywa i/t jest badaniem elektrodiagnostycznym pozwalającym ocenić stopień uszkodzenia nerwu obwodowego. Do badania stosuje się prąd stały o impulsach prostokątnych i trójkątnych. Czas trwania impulsów wynosi od 1000 ms do 0,05 ms. Celem niniejszego artykułu jest porównanie prawidłowych wartości parametrów pobudliwości czuciowej i ruchowej nerwu pośrodkowego przy pomocy krzywej i/t. Materiał. Przebadano 102 osoby: 70 kobiet i 32 mężczyzn, średnia wieku wyniosła 23 lata, u których na podstawie badania klinicznego nie stwierdzono zaburzeń w funkcji nerwu pośrodkowego. Wyniki. Istnieją różnice w zakresie wartości natężenia prądu niezbędnego do wywołania reakcji czuciowej i ruchowej dla impulsów prostokątnych i trójkątnych. Różnice obecne są również w wartościach: współczynnika i ilorazu akomodacji, reobazy oraz wartości progowej akomodacji Przebieg wykresu dla impulsów trójkątnych (o czasie trwania impulsu 1000 – 0,05 ms) obrazujący pobudliwość czuciową jest bardziej stromy w porównaniu do wykresu obrazującego pobudliwość ruchową nerwu pośrodkowego. Wnioski. Znajomość metodyki wykonania i sposobu interpretacji krzywej i/t może ułatwić fijoterapeutom zrozumienie i ocenę wyników uzyskanych za pomocą bardziej precyzyjnych badań, np. elektroneurografiznych. Krzywa i/t jest dostępną metodą pozwalającą potwierdzić fakt uszkodzenia nerwu obwodowego oraz monitorować przebieg procesu regeneracji i rehabilitacji. Wartości natężenia prądu niezbędne do wywołania reakcji ruchowej są około 1/3 wyższe niż dla reakcji czuciowej.Introduction. I/t curve is an accessible method of electrodiagnosis that allows determinate lesion degree of a peripheral nerve. The method utilizes triangularly and rectangularly shaped direct current impulses. Impulse length can vary from 1000 ms to 0,05 ms. The aim of this article is to compare the proper values of parameters of sensor and nervous – muscular agitation of the median nerve odtained throught the use of the i/t curve. source. The study group included 102 persons: 70 females and 32 males (average 23 years), clinically examined and no disorders were found in the function of the median nerve. results. There are existing diffrences in the value current intensity of the i/t curve of rectangular and triangular impulse between sensor and nervous – muscular agitation of the median nerve. Diffrences are present in the values of coefficient and accommodation quotient, rheobase, threshold value of accommodation. The chart for the triangular impulse (where impulse last from 1 – 0,05 ms) for sensor agitation shows a steeper curve in comparison to the curve of nervous – muscular agitation. Conclusion. Knowledge of methods of execution and how to interpret the i/t curve can be helpful for physiotherapist to understand and evaluate the results obtained using more accurate tests such as electroneurography. I/t curve is available method, to confirm the fact that peripheral nerve is damaged and monitor the process of healing and rehabilitatio