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

Suplementacja jodowa u ciężarnych z niedoczynnością tarczycy leczonych L-tyroksyną nie wpływa na stężenia TSH noworodków ani nie zapobiega obniżeniu stężeń wolnych hormonów tarczycy u matek w drugim i trzecim trymestrze

  Introduction: Pregnant women require about 250 μg of iodine daily. Hypothyroid women treated with L-thyroxine do not utilise iodine, and metabolism of L-thyroxine tablets is an additional source of iodine for their foetuses. The aim of the study was to evaluate the influence of iodine supplementation in hypothyroid pregnant women treated with L-thyroxine on neonate TSH concentration and maternal thyroid parameters. Material and methods: Ninety-two pregnant women with primary hypothyroidism on adequate thyroid hormone replacement were voluntarily divided into two groups: “thyroxine” (n = 38) treated with L-thyroxine only, and “thyroxine + iodine” (n = 54) treated additionally with 150 μg/day of iodine since 10th gestational week. Primary outcomes were the maternal thyroid function tests (TSH, fT4, fT3) and neonatal TSH concentrations at the 3–4th day of life. Urinary iodine concentration was measured at first and third trimester to compare iodine status in both groups. Results: Iodine supplementation significantly increased median urinary ioduria in the third trimester (from 95.15 μg/L to 151.50 μg/L), but did not prevent the decrease of maternal fT4 and fT3 concentrations in the second and third trimester. Median neonate TSH concentration in both groups was within normal range, but was 33% higher in the “thyroxine + iodine” than in the “thyroxine” group (1.91 mU/L vs. 1.34 mU/L). Moreover, 8.77% of newborns in the “thyroxine + iodine” group had TSH > 5 mIU/L. Conclusions: We did not find evidence for a positive influence of iodine supplementation on thyroid function of either hypothyroid pregnant women sufficiently treated with L-thyroxine or their neonates. (Endokrynol Pol 2016; 67 (4): 367–374)    Wstęp: U ciężarnych rekomendowana jest zwiększona podaż jodu pokrywająca zapotrzebowanie kobiety i dziecka. Tarczyca ciężarnej z niedoczynnością nie zużywa jodu. Jod dostarczony w diecie, suplementach oraz pochodzący z metabolizmu tyroksyny stanowi źródło wyłącznie dla płodu. Celem pracy była ocena wpływu suplementacji jodowej u ciężarnych z niedoczynnością tarczycy na stężenia TSH noworodków i parametry tarczycowe matek. Materiał i metody: Badanie przeprowadzono w grupie 92 ciężarnych z pierwotną niedoczynnością tarczycy wyrównaną w trakcie leczenia L-tyroksyną podzielono na dwie grupy: „tyroksyna” (n = 38) leczone jedynie tyroksyną i “tyroksyna + jod” (n = 54) otrzymujące tyroksynę i od 10. tygodnia ciąży jod 150 μg/dobę. U matek oznaczano TSH, fT4, fT3 w każdym trymestrze a u noworodków TSH w 3–4 dobie życia. Zaopatrzenie w jod oceniano na podstawie jodurii badanej w 1. i 3. trymestrze. Wyniki: Suplementacja jodowa spowodowała istotne zwiększenie mediany jodurii z 95,15 μg/l do 151,50 μg/l, jednak nie zapobiegła obniżeniu stężeń fT4 i fT3 w 2. i 3. trymestrze. W obu grupach mediana stężeń TSH noworodków utrzymywała się w granicach normy, ale była o 33% wyższa w grupie „tyroksyna + jod” niż w grupie „tyroksyna”(1,91 mU/l vs. 1,34 mU/l). Tylko w grupie „tyroksyna + jod” stwierdzono u noworodków stężenie TSH > 5 mIU/l co dotyczyło 8,77% badanych. Wnioski: Nie uzyskano dowodów na pozytywny wpływ suplementacji jodowej u ciężarnych z niedoczynnością tarczycy właściwie wyrównanych L-tyroksyną na TSH noworodków. Nie zaznaczył się także wpływ na parametry tarczycowe u kobiety ciężarnej. (Endokrynol Pol 2016; 67 (4): 367–374)

Real-time ultrasound elastography - a new tool for diagnosing thyroid nodules

Introduction: Real-time elastography (RTE) is a non-invasive ultrasound method of estimation of tissue stiffness by measuring the degree of local tissue displacements after a small compression. Recent data has shown its ability to differentiate benign from malignant tumours. The aim of this study was to evaluate the accuracy of RTE in the diagnosis of malignant and benign thyroid nodules. Material and methods: 71 thyroid nodules in 52 patients: 42 females and 10 males aged 28-77 were examined using conventional ultrasonography (US), fine-flow CD imaging and RTE. All nodules previously underwent fine-needle aspiration biopsy (FNAB), and patients with malignant and suspicious cytological results were referred for surgery. The final diagnosis was based on FNAB results in patients with benign cytology and on the histopathology reading in those who underwent surgery. An elasticity score (ES) from 1 to 5 was determined for each nodule according to the Ueno classification. Results: An elasticity score (ES) of 4 or 5 was found in 19 out of 22 (86.5%) thyroid cancers and in only 1 out of 31 (3%) benign nodules. This was strongly indicative for malignancy (p < 0.0001) with sensitivity 86%, specificity 97%, positive predictive value (PPV) 95% and negative predictive value (NPV) 91%. Conclusions: RTE is a highly sensitive and specific method of diagnosing thyroid nodules. This technique can be employed in selecting thyroid nodules for fine-needle aspiration biopsy. (Pol J Endocrinol 2010; 61 (6): 652-657)Wstęp: Elastografia czasu rzeczywistego (RTE, real-time elastography) jest nieinwazyjną metodą oceny twardości tkanki poprzez pomiar stopnia lokalnych przemieszczeń tkankowych pod wpływem słabego ucisku. Ostatnie dane wskazują na jej zdolność do różnicowania guzów łagodnych i złośliwych. Celem pracy była ocena dokładności diagnostycznej RTE w rozpoznawaniu złośliwych i łagodnych guzów tarczycy. Materiał i metody: Siedemdziesiąt jeden zmian ogniskowych tarczycy u 52 pacjentów: 42 kobiet i 10 mężczyzn w wieku 28-77 lat poddano badaniu ultrasonograficznemu w skali szarości, ocenie przepływów metodą fine-flow CD i RTE. Wszystkie zmiany były uprzednio poddane biopsji aspiracyjnej cienkoigłowej (BAC), a pacjenci z cytologicznym rozpoznaniem zmiany złośliwej lub podejrzanej byli kierowani do leczenia operacyjnego. Rozpoznanie ostateczne u pacjentów z cytologicznie stwierdzoną zmianą łagodną ustalono na podstawie wyniku BAC, zaś u poddanych operacji na podstawie wyniku badania histopatologicznego. Dla każdej zmiany oceniano wskaźnik elastyczności (ES) w skali od 1 do 5 zgodnie z klasyfikacją Ueno. Wyniki: Wskaźnik elastyczności 4 lub 5 stwierdzono w 19/22 (86,5%) raków tarczycy i tylko w 1/31 (3%) łagodnej zmianie ogniskowej. Wskazywał on silnie na złośliwość zmiany (p < 0,0001) z czułością 86%, swoistością 97%, dodatnią wartością predykcyjną 95% i ujemną wartością predykcyjną 91%. Wnioski: Elastografia czasu rzeczywistego jest wysoce czułą i swoistą metodą w diagnostyce zmian ogniskowych tarczycy. Technika ta może być stosowana do typowania zmian ogniskowych tarczycy wymagających biopsji aspiracyjnej cienkoigłowej. (Endokrynol Pol 2010; 61 (6): 652-657

Subclinical left ventricular systolic dysfunction in patients with naive acromegaly — assessment with two-dimensional speckle-tracking echocardiography: retrospective study

Introduction: The aim of the study was to evaluate global longitudinal strain (GLS) in patients with naive acromegaly with normal left ventricular (LV) ejection fraction (EF). Material and methods: Forty-three consecutive patients with naive acromegaly with normal LV systolic function as measured by EF, examined from 2008 to 2016, and 52 patients of a control group matched for age and sex underwent two-dimensional speckle-tracking echocardiography to assess GLS. Results: The median GLS was significantly lower in the acromegaly group than in the control group (in %, –16.6 vs. –20.7; p &lt; 0.01). The majority of acromegalic patients (n = 26; 60.5%) had abnormal GLS. Patients with impairment in GLS had a longer median duration of acromegaly symptoms (in years, 10.0 vs. 5.0; p &lt; 0.05) and greater LV thickness (posterior wall in mm, 12.5 vs. 12.0; p &lt; 0.05) compared to those with normal GLS. Patients with abnormal GLS had higher IGF-1 concentration, but without statistical significance. Diabetes mellitus and arterial hypertension, which are more common in acromegaly, were not significant determinants of abnormal GLS. The mean left ventricular mass index (LVMI) was increased in the acromegaly group compared to controls (in g/m2, 136 vs. 97; p &lt; 0.01). There wasa significant negative correlation between LVMI and GLS (R = –0.47; p &lt; 0.01). Conclusions: Naive acromegalic patients presented abnormal GLS, which indicates subclinical systolic dysfunction in these patients. It has not been proven that arterial hypertension and diabetes mellitus are significant determinants of abnormal GLS

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

Działania opiekuńcze w profilaktyce i terapii

Praca recenzowana / Peer-reviewed paperOpieka jest potrzebna wszystkim, zarówno dzieciom, jak i dorosłym, a w sposób szczególny osobom starszym, w tym terminalnie chorym. Prezentowane w niniejszej monografi i teksty uwzględniają właśnie tę wieloczynnikową aktywność opiekuńczą. Autorami poszczególnych rozdziałów są pracownicy naukowi zaangażowani w proces edukacyjny w zakresie nauk o zdrowiu, pracujący w Krakowskiej Akademii im. Andrzeja Frycza Modrzewskiego, ale także studenci PWSZ w Tarnowie. W różnorodnym zakresie przedstawili i omówili oni główne tezy monografii

Primary hyperparathyroidism: clinical manifestations, diagnosis and evaluation according to the Fifth International Workshop guidelines

Primary hyperparathyroidism (PHPT) is a frequent endocrine disease which mainly affects the skeletal system and kidney. Some of its signs and symptoms are similar to those seen in rheumatic diseases such as rheumatoid arthritis, Sjögren’s disease, fibromyalgia, polymyalgia rheumatica, gout or systemic lupus erythematosus. Coexistence of primary hyperparathyroidism with those pathologies potentiate their effects on muscles, bones and joints, increasing the risk of complications such as osteoporosis and fractures. Therefore, rheumatologists should be familiar with symptoms and diagnostic criteria of PHPT and consider it in the differential diagnosis of rheumatic diseases. In 2022 the Fifth International Workshop guidelines on the PHPT evaluation and management were published. They are based on a profound analysis of advances in research concerning multiple fields, that include genetics, outcomes and new imaging modalities of PHPT. They have led to revision of previous renal indications for parathyroidectomy in PHPT. There is also more evidence for the other recommendations regarding evaluation of the disease. This article summarizes the most relevant elements of these recommendations and refers them to Polish realities. I focus on the symptoms of primary hyperparathyroidism and its diagnosis as I consider these areas to be the most important for non-endocrinologists

The use of Kinesio Taping in edema treatment after primary knee arthroplasty. A case study

A knee joint is one of the most exposed to the degenerative injuries causing pain and reducing motion abilities. In case of ineffective conservative treatment and advanced degenerative changes, a patient may be referred for knee arthroplasty. This surgery is often followed by pain and limb edema. Postoperative treatment can be supported by the Kinesio Taping. This paper aims to present the Kinesio Taping as a supportive post-surgery pain and edema treatment after knee arthroplasty. The 67-year-old-patient has been treated conservatively for the last 7 years. Due to the deteriorating changes and increasing pain the patient had been referred for the left knee arthroplasty procedure. After the surgery, the patient was stable, therefore the standard post-surgery procedures were implied. On the 3rd day, the lymphatic technique of the Kinesio Taping was added. After the end of the therapy (10th day after the surgery) the tests have shown a significant decrease of subcutaneous tissue swelling, pain relief, and knee joint circumference reduction

What’s new in airway secretions clearance for adults? A systematic review

Introduction. Airway clearance techniques are an essential part of routine respiratory physiotherapy, enabling bronchial secretion clearance—the mucus overproduction and retaining results in lung function deterioration and disrupts effective pulmonary rehabilitation. Several mucus clearance methods are included in the physiotherapy daily routine of patients with chronic lung conditions; nevertheless, new techniques and approaches are continuously developed. Aim. Thus, this systematic review summarizes novel airway clearance techniques applied in patients with chronic pulmonary conditions. Material and methods. The PubMed, Cochrane Library, and PEDro databases were searched from 2010 to 2021, and studies were selected based on eligibility criteria. Analysis of the literature. 101 patients from five studies describing four different techniques were included. Novel techniques were non-invasive ventilation, intrapulmonary percussive ventilation, trachea vibration, and PEP-sound wave combination. Significant improvements were noted for ventilation homogeneity (NIV), saturation (NIV), respiratory rate (IPV), and diffusion capacity (VL), whereas cardiovascular function and exercise endurance did not change significantly. Conclusion. The presented methods are considered to have similar effectiveness as well-known airway clearance techniques. However, the systematic use of presented methods in routine pulmonary rehabilitation must be preceded by in-depth investigation to provide no-bias results