External load application in gait and posture reeducation after diffuse axonal injury of the corpus callosum. A case report

Traumatic brain injury caused car accidents is the one of the most common causes of diffuse axonal injury typically located at the grey-white matter junction, in the corpus callosum. A 58-year-old female patient Caucasian race was admitted to the Orthopedic and Rehabilitation Unit with head injury, broken right ulnar bone, numerous broken ribs and broken right iliac crest. Neurological examination resulted in right-sided hemiparesis. There were also coordination and balance disorders while sitting and standing. The patient was unable to walk. After physiotherapy treatment included external load application (ankle weights and rucksack with weights) in gait and posture reeducation, patient has improved balance, locomotion and body posture. However, application of external loads during walk and posture reeducation needs to be further investigated with greater number of participants and control group

Tissue coverage of paclitaxel and sirolimus eluting stents in long term follow-up: Optical coherence tomography study

Background: Implantation of drug eluting stents (DES) has become a standard treatment ofpatients undergoing percutaneous coronary intervention (PCI). Incomplete strut coverage isa potential risk factor for late stent thrombosis. Optical coherence tomography (OCT) enablesin vivo identification of incomplete neointimal coverage.Methods: Study included 62 patients after sirolimus eluting stents (SES) or paclitaxel elutingstents (PES) implantation. OCT examination was performed at least 24 months after theinitial procedure (35.4± 9.4 months). In cross-sectional still frames selected from each 1 mm ofanalyzed stents a total number of visible struts and number of struts with or without completeneointimal coverage was assessed. Measurements of neointimal coverage, presented as a meanthickness of tissue, were performed. Patients were followed up for 3 years and the frequency ofmajor adverse cardiac events was recorded.Results: In the analyzed 28 SES and 37 PES 9998 struts were identified. Complete neointimalcoverage was observed in 83.5% and 79.2% of SES and PES struts respectively (p = 0.48).There was no difference in incidence of not covered or malapposed struts between SES and PES groups. Mean thickness of the tissue covering SES struts was 0.165 ± 0.095 mm, and 0.157 ± 0.121 mm for PES. The mean neointimal thickness difference (SES vs. PES) was notstatistically significant. In a 36 months follow-up 1 death was observed — potentially attributedto stent thrombosis.Conclusions: A long term OCT follow-up after DES implantation shows high incidence ofuncovered struts regardless of the stent type. Clinical significance of this finding remains questionableand requires further large scale trials

Analysis of oncological diseases in the Subcarpathian Oncology Center in 2007 – 2011

Introduction: Cancers are a growing health, social and economic problem of society worldwide. They are the second cause of mortality in Poland, causing 27% of deaths among men and about 24% of deaths among women. For several decades, there has been a steady increase in morbidity and mortality due to malignant tumors. The increase in morbidity of oncological diseases is related to aging of the population and increasing exposure to carcinogens such as poor diet, alcohol consumption and smoking, stress, environmental pollution as well as genetic inheritance. Data of morbidity and mortality caused by cancers in Poland has been published by Oncology Center in Warsaw since 1979. Aim of the study: to analyze selected oncological diseases of patients of the Subcarpathian Oncology Center in Brzozów, Poland in 2007-2011 as well as to compare them with data based on national oncology statistics in Poland. Material and methods: the material were records of selected oncological diseases of 10520 patients (6053 women and 4467 men; aged 2 – 98) of the Subcarpathian Oncological Center in Brzozów, Poland in 2007-2011. Results: The highest morbidity occurred in the group aged 40 – 59, the lowest in the group aged 90 – 100. The greatest morbidity rate was noted for breast cancer and the lowest morbidity rate was noted for cervical cancer. Conclusion: The cervical cancer morbidity decreases and it may be the evidence of the raising awareness, prevention and complex medical diagnostics. Morbidity rate for skin cancer increases therefore it is necessary to implement programs related to the prevention of this cancer

Mitral and aortic regurgitation following transcatheter aortic valve replacement

OBJECTIVE: To analyse the impact of postprocedural mitral regurgitation (MR), in an interaction with aortic regurgitation (AR), on mortality following transcatheter aortic valve implantation (TAVI). METHODS: To assess the interaction between MR and AR, we compared the survival rate of patients (i) without both significant MR and AR versus (ii) those with either significant MR or significant AR versus (iii) with significant MR and AR, all postprocedure. 381 participants of the Polish Transcatheter Aortic Valve Implantation Registry (166 males (43.6%) and 215 females (56.4%), age 78.8±7.4 years) were analysed. Follow-up was 94.1±96.5 days. RESULTS: Inhospital and midterm mortality were 6.6% and 10.2%, respectively. Significant MR and AR were present in 16% and 8.1% patients, including 3.1% patients with both significant MR and AR. Patients with significant versus insignificant AR differed with respect to mortality (log rank p=0.009). This difference was not apparent in a subgroup of patients without significant MR (log rank p=0.80). In a subgroup of patients without significant AR, there were no significant differences in mortality between individuals with versus without significant MR (log rank p=0.44). Significant MR and AR had a significant impact on mortality only when associated with each other (log rank p<0.0001). At multivariate Cox regression modelling concomitant significant MR and AR were independently associated with mortality (OR 3.2, 95% CI 1.54 to 5.71, p=0.002). CONCLUSIONS: Significant MR or AR postprocedure, when isolated, had no impact on survival. Combined MR and AR had a significant impact on a patient's prognosis

The role of a support person during labour

Introduction: The changes that have occurred in the obstetrics in the last years are not only culturally conditioned, but they also constitute the sum of experiences of many generations of the women in labour. The change of a labour management style and the partner’s presence at that time is the result of variable expectations of women as well as the courage and determination of representatives of medical professions. When both partners are aware and active during the labour, a mother has the comfort of giving a birth in the sense of safety, and the father feels the full acceptance of a child as it eliminates the fear of physical contact with a baby. Objectives: The objective of this work is to know the opinion of women about the support person during labour. Materials and methods: The anonymous surveys were used as the research method. The study involved 187 women in labour, after the family labour in the average age of 29 ± 10 years. It was directed at the women after the family labour to know their opinion about the role of a support person during labour. Results: The conducted analysis has proved that the couples make decision together as to the family labour 59.4%. The factors that influence on this decision are the following to stay together (53.5%) and to provide the sense of safety (38.5%). According to 87.7% of the surveyed, the major type of the partner’s activity during the labour was his emotional support. 90.9% of the women confirm their partner would participate during the another labour again. Conclusions: 1.The decision about the family labour is made together by both partners. 2.Because of the partner’s presence during a labour, there are more chances for the better relationship of a man with his child in the future. 3.The major motivation for the man’s presence during the labour is to provide the sense of safety to his woman in labour

Bilateral, incidentally found adrenal tumours - results of observation of 1790 patients registered at a single endocrinological centre

Wstęp: W okresie ostatnich 22 lat 1790 pacjentów z przypadkowo wykrytymi guzami nadnerczy (AI, adrenal incidentalomas) zostało zarejestrowanych w klinice. U 351 spośród nich rozpoznano obustronne guzy nadnerczy. Nasze badania miały na celu analizę charakteru obustronnych guzów i podsumowanie metod postępowania w tych przypadkach. Materiał i metody: W całej grupie 1790 pacjentów było 1311 kobiet i 479 mężczyzn, w wieku 11-87 lat. Grupa pacjentów z obustronnymi guzami nadnerczy obejmowała 258 kobiet i 93 mężczyzn, w wieku 25-83 lat. Przeprowadzono badania hormonalne i obrazowe, w celu poszukiwania podklinicznej nadczynności nadnerczy i określenia potencjału złośliwości guzów. Wyniki: Chirurgicznie leczono 69 pacjentów, ze wskazań onkologicznych albo endokrynologicznych (głównie podkliniczny zespół Cushinga). Wyniki badań histologicznych wykazały istnienie złośliwych zmian nowotworowych: przerzuty - 9, rak nadnercza - 7, chłoniaki - 5 i niezłośliwych zmian: gruczolaki - 24, rozrost guzkowy - 14, myelolipoma - 4, pheochromocytoma - 4 przypadki. Podkliniczny zespół Cushinga występował względnie częściej w rozroście guzkowym (40%) niż w przypadkach gruczolaka (30%). Wnioski: Wskazania do leczenia chirurgicznego ustalono u 20% pacjentów z obustronnymi guzami nadnerczy, najczęściej z powodu gruczolaków, rozrostu guzkowego i złośliwych zmian nowotworowych; rokowanie było dobre w przypadkach nieonkologicznych. (Endokrynol Pol 2010; 61 (1): 69-73)Introduction: During the last 22 years we registered 1790 patients with incidentally found adrenal tumours (AI, adrenal incidentalomas). In 351 of them, bilateral tumours were detected. The aim of our study was to analyze the character of bilateral tumours and summarize the methods of their management. Material and methods: In the whole group of 1790 patients, there were 1311 women and 479 men, aged 11-87 years. The group of patients with bilateral adrenal tumours included 258 women and 93 men, 25-83 years old. Hormonal investigations and imaging examinations were performed to search for subclinical adrenal hyperfunction and to define the malignant potential of the tumours. Results: Sixty-nine patients were treated by surgery for oncological or endocrinological purposes (mainly pre-Cushing&#8217;s syndrome). Histological findings included malignant tumours: metastases - 9, adrenal cancer - 7, and lymphomas - 5; and non-malignant tumours: adenomas - 24, nodular hyperplasia - 14, myelolipomas - 4, and pheochromocytomas - 4. Subclinical Cushing&#8217;s syndrome was relatively more frequent in nodular hyperplasia (40%) than in adenomas (30%). Conclusions: Indications for surgery were recommended in 20% of patients with bilateral AI, most frequently for adenomas, nodular hyperplasia, and oncological pathologies, with a good prognosis in the non-malignant group. (Pol J Endocrinol 2010; 61 (1): 69-73

Prediction of left ventricular function in patients after acute myocardial infarction treated with primary angioplasty

Background: Despite a substantial reduction in in-hospital mortality, the long-term outcomes of patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous transluminal coronary angioplasty (PTCA) remain uncertain. The main causes include progressive left ventricle (LV) remodelling and impaired LV systolic function with a decreased ejection fraction (EF). B-type natriuretic peptide testing has recently emerged as an innovative approach that might enhance the echocardiography-based risk stratification after STEMI. The aims of the study included long-term echocardiographic assessment of LV function and remodelling in patients with STEMI treated with PTCA. Additionally, evaluation of the N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma level utility was performed to identify factors at patient discharge which would enable to predict LV dysfunction and remodelling after STEMI at 6-month follow-up. Methods: Echocardiography was performed in 98 patients at discharge and at 6-month follow-up. The diameters of the heart chambers and indices of LV systolic and diastolic function were measured. Plasma levels of NT-proBNP were measured before PTCA and at 6 months. Results: Primary PTCA successfully restored normal epicardial blood flow in the infarctrelated Artery (IRA) in 96 patients. At 6 months preserved LV systolic function (median EF 47.5%), decreased LV diastolic function with relaxation abnormalities (E/A < 1.0 and IVRT > 105 ms) and no significant increase in left ventricular end-diastolic diameter (LVEDD) were observed in study population. Multivariate analysis identified low baseline NT-proBNP level, low peak creatine phosphokinase (CPKmax) activity and high EF at discharge as powerful independent predictors of preserved EF at 6 months. LVEDD at discharge, baseline NT-proBNP level and CPKmax correlated with LVEDD at 6 months in the multiple regression model. In multivariate analysis a high NT-proBNP level on admission and low LVEDD at discharge were independent predictors of LVEDD change. Patient groups with reperfusion obtained 3.2 h from symptom onset (the median delay) did not differ with respect to IRA blood flow, infarct size assessed as CPKmax and LVEDD at 6 months. A significant increase in EF was noted only in patients with chest pain duration < 3.2 h. Time-to-treatment correlated with NT-proBNP level at 6 months. Conclusions: Successful primary PTCA in STEMI influences LV systolic function improvement and effectively prevents LV remodelling at the 6-month follow-up. Low baseline NT-proBNP, low CPKmax and high EF at discharge are powerful independent predictors of preserved EF after 6 months. A high NT-proBNP level on admission and low LVEDD at discharge predict a propensity for LV remodelling. A prolonged time-to-treatment of STEMI results in a lack of significant long-term improvement in LV systolic function and does not seem to have an impact on the occurrence of LV remodelling