22 research outputs found
Anterior odontoid screw fixation extrusion as reason for oesophagus perforation
Background. Type II odontoid fractures are mostly encountered in the elderly. Due to a high risk of non-union fractures in the case of conservative treatment, surgical fixation is widely recommended. Anterior odontoid screw fixation (AOSF) is a method that allows for a wide range of cervical mobility, and it is a relatively safe procedure that is recommended as the method of choice, although rare complications can be fatal when it leads to life-threatening oesophageal perforation. Purpose. The aim of this study is to present potential risk factors which lead to these rare complications, and possible methods of treatment.Methods. This article presents the case of a patient hospitalised in the Neurosurgery Department of St Lukas Hosital in Tarnów in 2016. A literature review was performed using PubMed; search criteria included the phrases ‘odontoid fracture perforation’ and ‘anterior cervical spine perforation’. The search returned 235 articles, of which 55 publications were in line with the subject of this paper, with only 12 deemed appropriate for consideration.Result. The authors present the case of an elderly patient with a history of odontoid fracture. Ten weeks after primary AOSF, the patient came to the Neurosurgery Department due to expectorating screws. This implied the need for further examination and even oesophageal reconstructive surgery or another spinal surgery. In laryngological examination and in gastroscopy there were no signs of fistula. In this case conservative treatment was proceeded. Due to odontoid fracture, non-union cervical posterior stabilisation was necessary.Conclusion. Patients with oesophageal perforation should be treated with special care
Assessment of cervical range of motion in patients after axis fracture
Background
Surgical treatment of odontoid fractures with posterior C1/C2 fusion always leads to severe limitations in mobility of the cervical spine and head.
Purpose
To assess the mobility of the cervical spine in patients treated with various surgical methods after an axis body fracture.
Material and methods
A group of 61 subjects receiving surgical treatment in a group of 214 subjects treated for odontoid fractures at one ward of neurosurgery at a regional hospital. Studies also included odontoid peg and Hangman fractures. The range of motion of the head was compared to standards by the International Standard Orthopedic Measurements (ISOM) and to head mobility in a control group of 80 healthy subjects without any pathologies or complaints associated with the cervical spine. Ranges of motion were measured with the CROM goniometre with regard to flexion, extension, right and left lateral flexion and right and left rotation. The functional status was evaluated with Neck Disability Index (NDI) standard questionnaires indicated for patients with cervical spine pain.
Results
Except for flexion and extension, patients after odontoid fractures had a statistically significantly smaller range of motion of the cervical spine in all planes compared to the control group and ISOM standards.
Conclusions
Odontoid fractures lead to limitations in mobility of the cervical spine even after treatment with methods that in theory should preserve the C1/C2 mobility
Long-term antibiotic prophylaxis in urology and high incidence of "Clostridioides difficile" infections in surgical adult patients
Clostridioides difficile infections are the main cause of antibiotic-related diarrhea. Most of them come in the form of healthcare-associated Clostridioides difficile infections (HA-CDI). The aim of the study was to analyze HA-CDI epidemiology and the relationship between antibiotic consumption and CDI epidemiology at St Luke’s Provincial Hospital in Tarnow, Poland. In 2012–2018, surveillance of CDI was carried out in adult surgical wards at St Luke’s Provincial Hospital. The data were collected in accordance with the methodology of the Healthcare-Associated Infections Surveillance Network (HAI-Net), European Centre for Disease Prevention and Control (ECDC), and the ATC/DDD system (Anatomical Therapeutic Chemical Classification System) of the World Health Organization. In total, in the study period, 51 cases of CDI involved CA-CDI (24.5%) and 147 were HA-CDIs (75.5%). The most CA-CDIs were found in the general surgery (32.6%) and urology (17.0%) wards. CA-CDI incidence was 0.7/1000 patients and for HA-CDI it was 2/1000 patients (4.4/10,000 patientdays (pds)). The highest HA-CDI incidence was in the neurosurgical departments (18/10,000 pds) and oncological surgery (8.4/10,000) pds. There was a significant positive correlation between CA-CDI and HA-CDI (correlation of 0.943, p < 0.001) and between the number of patients hospitalized and HA-CDI (correlation of 0.865, p = 0.012). The total antibiotic consumption amounted to 0.7 DDD/10,000 pds; it was the highest in the urology ward (0.84/10,000 pds) and 49.5% of the antibiotics were fluoroquinolones (0.41/10,000 pds). On the basis of regression coefficients, a positive correlation was demonstrated between the use of fluoroquinolones and the HA-CDI incidence rate. Both a high percentage of CDI cases and a high intake of antibiotics were recorded in the urology department. About half of all antibiotics were fluoroquinolones
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
Husserl a Ingarden. Z Andrzejem Półtawskim rozmawia Marek Maciejczak
Husserl and IngardenIn the conversation professor Połtawski presents his opinions on the most important aspects of philosophical systems of Husserl and Ingarden.Husserl and IngardenIn the conversation professor Połtawski presents his opinions on the most important aspects of philosophical systems of Husserl and Ingarden
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
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