In-hospital rehabilitation in the treatment of multiple myeloma

Wprowadzenie:  Szpiczak mnogi (MM) jest jednym z najczęstszych złośliwych nowotworów kości. Podstawową procedurą leczenia szpiczaka mnogiego jest chemioterapia połączona z autologicznym przeszczepem komórek macierzystych. Leczenie operacyjne, polegające na wycięciu guza, jest wskazane, gdy istnieje ryzyko patologicznego złamania kości lub ucisku guza na korzenie nerwowe. Konieczne jest stworzenie indywidualnego planu leczenia we współpracy interdyscyplinarnej. Ważnym elementem leczenia jest pomoc w zakresie rehabilitacji. Celem pracy było wskazanie procedur rehabilitacyjnych w leczeniu szpiczaka mnogiego po rekonstrukcji endoprotezy w okresie szpitalnym.Materials and methods: The work was written based on the medical history of a patient diagnosed with multiple myeloma in the proximal part of the right femur. The entire treatment procedure was carried out at the Department of Orthopedics, Traumatology and Oncology of the Musculoskeletal System, located at Unii Lubelskiej 1 in Szczecin.Results: Rehabilitation in the treatment process of patients after resection of the tumor in the proximal part of the femur and arthroplasty is implemented as early as 1 day after the surgery in order to activate the patient as soon as possible. The rehabilitation program was as individualized as possible to the patient and included modern techniques such as osteopathy and manulana therapy.Wniosek: Rehabilitacja jest nieodzownym elementem leczenia chorych na nowotwory. Wprowadzenie do rehabilitacji nowoczesnych technik wpływa pozytywnie na skuteczność terapii. Wczesne rozpoczęcie rehabilitacji przynosi wymierne korzyści w trakcie leczenia i powrót pacjenta do aktywnego udziału w życiu społecznym

Alder pollen season in poland in 2018

Alder pollen grains constitute the important allergen sources in this respect in the Northern Hemisphere. The aim of the study was to investigate the concentration of alder (Alnus spp.) in Bialystok, Bydgoszcz, Cracow, Drawsko Pomorskie, Lublin, Olsztyn, Opole, Piotrkow Trybunalski, Sosnowiec, Szczecin, Warsaw, Wroclaw and Zielona Gora in 2018. Measurements were performed by the volumetric method (Burkard and Lanzoni pollen samplers). Seasonal Pollen Index (SPI) was estimated as the annual sum of daily average pollen concentrations. The pollen season of alder in all Polish stations began on the 11th and 13th March and the high concentration persisted until the first days of April. The highest, record airborne concentration of 1068 pollen grains/m3 was noted in Lublin on the 13th March. The peak values of seasonal pollen count occurred between of 11th March and 4th April in all cities. In 2018 pollen concentration of alder was one of the lowest in all analysed cities

Maple pollen season in selected cities of Poland in 2018

The study compares the maple pollen seasons in Bialystok, Bydgoszcz, Cracow, Drawsko Pomorskie, Sosnowiec, Lublin, Olsztyn, Opole, Piotrkow Trybunalski, Szczecin, Warsaw and Zielona Gora in 2018. The investigations were conducted using the volumetric method. The maple season started in all sites in the first decade of April, with the exception of Sosnowiec, where the season began already on March 16th. The peak values of seasonal pollen count occurred between 12th–20th April in all cities. The highest daily pollen count was recorded in Sosnowiec and in Lublin on the same day (12th April) in both cities. The greatest risk of allergies caused by the presence of airborne maple pollen was observed in Sosnowiec, Lublin and Opole

Hornbeam pollen in the air of Poland in 2018

The study compares the hornbeam pollen seasons in Bialystok, Bydgoszcz, Drawsko Pomorskie, Zielona Gora, Opole, Sosnowiec, Cracow, Piotrkow Trybunalski, Warsaw, Lublin, Olsztyn and Szczecin in 2018. The investigations were carried out using the volumetric method (Hirst type pollen sampler). Seasonal Pollen Index was estimated as the sum of daily average pollen concentrations in the given season. Pollen season was defined as the period in which 98% of the annual total catch occurred. The pollen season of hornbeam started first in Bialystok, on the April 3rd. At the latest, a pollen season ended in Lublin and Sosnowiec at the beginning of May. However, in most other cities the season lasted till the end of April. The differences of pollen seasons duration were considerable, from 16 to 36 days. The highest airborne concentration of 168 pollen grains/m3 was noted in Lublin on the April 14th. The maximum values of seasonal pollen count occurred between April 12th and 16th. The highest hornbeam pollen allergen hazard occurred in 2018 in Lublin, Warsaw and Piotrkow Trybunalski

The oak pollen concentration in the air of selected cities in Poland in 2018

This paper contains an analysis of oak pollen seasons in selected cities of Poland in 2018. Sampling sites were located in the following cities: Bialystok, Bydgoszcz, Cracow, Drawsko Pomorskie, Lublin, Olsztyn, Opole, Piotrkow Trybunalski, Sosnowiec, Szczecin, Warsaw, Wroclaw and Zielona Gora. The volumetric method was applied using the Burkard or Lanzoni trap. The pollen season was determined by the 98% method. The season started earliest in Sosnowiec (April 14th). The mean duration of the pollen season was 33 days. The highest pollen concentration (713 P/m3) was observed in Wroclaw (April 19th). The peak values were recorded between April 19th and May 1st in the different cities

Ambrosia pollen season in selected cities in Poland in 2018

Ambrosia causes most pollen allergies in North America. After several Ambrosia species were introduced to Europe, an increase in the incidence of allergy to pollen of these plants has been observed in many countries. The aim of this study was to compare Ambrosia pollen seasons in 2018 in 13 cities located in different regions of Poland: Bialystok, Bydgoszcz, Cracow, Drawsko Pomorskie, Lublin, Olsztyn, Opole, Piotrkow Trybunalski, Sosnowiec, Szczecin, Warsaw, Wroclaw and Zielona Gora. The study was conducted by the volumetric method using Burkard or Lanzoni pollen samplers. The pollen season was determined by the 98% method. The earliest pollen season start dates (the end of July) were recorded in Zielona Gora, Bydgoszcz, Opole and Szczecin, while the latest ones in Drawsko Pomorskie and Bialystok. The longest pollen seasons occurred in Opole, Szczecin and Zielona Gora (79 days). The highest average daily concentrations of Ambrosia pollen were recorded in Bialystok (129 P/m3) and Lublin (99 P/m3), while the lowest ones in Drawsko Pomorskie and Szczecin (4 and 10 P/m3, respectively). The annual pollen sum reached the highest value in Opole (567 pollen grains) and Zielona Gora (555 pollen grains). It can be concluded from the pattern of Ambrosia pollen seasons at the monitoring sites studied that pollen of this taxon originates not only from Ambrosia locations in Poland but also from long-distance transport

Analysis of Fraxinus pollen seasons in selected cities of Poland in 2018

The study compares the ash pollen seasons in Szczecin, Drawsko Pomorskie, Bydgoszcz, Zielona Gora, Wroclaw, Opole, Sosnowiec, Cracow, Piotrkow Trybunalski, Warsaw, Lublin, Olsztyn and Bialystok in 2018. The investigations were carried out using the volumetric method. The ash pollen season began between April 7th and April 10th. Maximum daily pollen concentrations were noted earliest on April 10th and latest on April 17th. The greatest risk of allergies caused by the presence of airborne ash pollen was observed in Lublin

LUMiC(A (R)) Endoprosthetic Reconstruction After Periacetabular Tumor Resection:Short-term Results

Reconstruction of periacetabular defects after pelvic tumor resection ranks among the most challenging procedures in orthopaedic oncology, and reconstructive techniques are generally associated with dissatisfying mechanical and nonmechanical complication rates. In an attempt to reduce the risk of dislocation, aseptic loosening, and infection, we introduced the LUMiC(A (R)) prosthesis (implantcast, Buxtehude, Germany) in 2008. The LUMiC(A (R)) prosthesis is a modular device, built of a separate stem (hydroxyapatite-coated uncemented or cemented) and acetabular cup. The stem and cup are available in different sizes (the latter of which is also available with silver coating for infection prevention) and are equipped with sawteeth at the junction to allow for rotational adjustment of cup position after implantation of the stem. Whether this implant indeed is durable at short-term followup has not been evaluated. (1) What proportion of patients experience mechanical complications and what are the associated risk factors of periacetabular reconstruction with the LUMiC(A (R)) after pelvic tumor resection? (2) What proportion of patients experience nonmechanical complications and what are the associated risk factors of periacetabular reconstruction with the LUMiC(A (R)) after pelvic tumor resection? (3) What is the cumulative incidence of implant failure at 2 and 5 years and what are the mechanisms of reconstruction failure? (4) What is the functional outcome as assessed by Musculoskeletal Tumor Society (MSTS) score at final followup? We performed a retrospective chart review of every patient in whom a LUMiC(A (R)) prosthesis was used to reconstruct a periacetabular defect after internal hemipelvectomy for a pelvic tumor from July 2008 to June 2014 in eight centers of orthopaedic oncology with a minimum followup of 24 months. Forty-seven patients (26 men [55%]) with a mean age of 50 years (range, 12-78 years) were included. At review, 32 patients (68%) were alive. The reverse Kaplan-Meier method was used to calculate median followup, which was equal to 3.9 years (95% confidence interval [CI], 3.4-4.3). During the period under study, our general indications for using this implant were reconstruction of periacetabular defects after pelvic tumor resections in which the medial ilium adjacent to the sacroiliac joint was preserved; alternative treatments included hip transposition and saddle or custom-made prostheses in some of the contributing centers; these were generally used when the medial ilium was involved in the tumorous process or if the LUMiC(A (R)) was not yet available in the specific country at that time. Conventional chondrosarcoma was the predominant diagnosis (n = 22 [47%]); five patients (11%) had osseous metastases of a distant carcinoma and three (6%) had multiple myeloma. Uncemented fixation (n = 43 [91%]) was preferred. Dual-mobility cups (n = 24 [51%]) were mainly used in case of a higher presumed risk of dislocation in the early period of our study; later, dual-mobility cups became the standard for the majority of the reconstructions. Silver-coated acetabular cups were used in 29 reconstructions (62%); because only the largest cup size was available with silver coating, its use depended on the cup size that was chosen. We used a competing risk model to estimate the cumulative incidence of implant failure. Six patients (13%) had a single dislocation; four (9%) had recurrent dislocations. The risk of dislocation was lower in reconstructions with a dual-mobility cup (one of 24 [4%]) than in those without (nine of 23 [39%]) (hazard ratio, 0.11; 95% CI, 0.01-0.89; p = 0.038). Three patients (6%; one with a preceding structural allograft reconstruction, one with poor initial fixation as a result of an intraoperative fracture, and one with a cemented stem) had loosening and underwent revision. Infections occurred in 13 reconstructions (28%). Median duration of surgery was 6.5 hours (range, 4.0-13.6 hours) for patients with an infection and 5.3 hours (range, 2.8-9.9 hours) for those without (p = 0.060); blood loss was 2.3 L (range, 0.8-8.2 L) for patients with an infection and 1.5 L (range, 0.4-3.8 L) for those without (p = 0.039). The cumulative incidences of implant failure at 2 and 5 years were 2.1% (95% CI, 0-6.3) and 17.3% (95% CI, 0.7-33.9) for mechanical reasons and 6.4% (95% CI, 0-13.4) and 9.2% (95% CI, 0.5-17.9) for infection, respectively. Reasons for reconstruction failure were instability (n = 1 [2%]), loosening (n = 3 [6%]), and infection (n = 4 [9%]). Mean MSTS functional outcome score at followup was 70% (range, 33%-93%). At short-term followup, the LUMiC(A (R)) prosthesis demonstrated a low frequency of mechanical complications and failure when used to reconstruct the acetabulum in patients who underwent major pelvic tumor resections, and we believe this is a useful reconstruction for periacetabular resections for tumor or failed prior reconstructions. Still, infection and dislocation are relatively common after these complex reconstructions. Dual-mobility articulation in our experience is associated with a lower risk of dislocation. Future, larger studies will need to further control for factors such as dual-mobility articulation and silver coating. We will continue to follow our patients over the longer term to ascertain the role of this implant in this setting. Level IV, therapeutic study

Recommendations for diagnostics and therapy of adult patients with malignant primary bone tumors

Bone sarcomas comprise a heterogenous group of rare mesenchymal tumors (less than 0.5% of malignant neoplasms in adults). From clinical point of view they can be divided into two main groups: spindle-cell sarcomas (osteosarcomas, majority of chondrosarcomas and less common subtypes) and small-cell sarcomas (mainly Ewing family of tumors). Correct diagnosis and effective therapy is performed by cooperation of radiologists, oncological and orthopedics surgeons, clinical oncologists, radiotherapists, rehabilitants, pathologists, nuclear medicine specialists and molecular biologists. The most important principle in diagnostics and therapy of primary malignant bone tumors is multidisciplinary work in experienced centers. Improvement of diagnostics, implementation of combined therapy and technological developments caused the increase of limb-sparing surgery indications and better long-term results of their treatment. Onkol. Prak. Klin. 2010; 6, 6: 355–369Mięsaki kości u dorosłych stanowią heterogenną grupę bardzo rzadkich nowotworów pochodzenia mezenchymalnego (poniżej 0,5% nowotworów złośliwych u dorosłych). Pod względem klinicznym mięsaki kości można podzielić na mięsaki wrzecionowatokomórkowe (obejmujące mięsaki kościopochodne, większość chrzęstniakomięsaków i inne rzadsze podtypy) oraz drobnokomórkowe (głównie rodzina mięsaków Ewinga). 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. Onkol. Prak. Klin. 2010; 6, 6: 355–36

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