Rezultati procesa rehabilitacije pacijenata poslije operacije lumbalne diskus hernije u Rehabilitacionom centru Vilina Vlas, Višegrad

Uvod. Oko 80% ljudi u svijetu bar jednom tokom života osjeti bolove u slabinskomdijelu kičmenog stuba. Lumbalni sindrom je značajan zbog svojeučestalosti i osobine da recidivira, što ovom zdravstvenom problemu dajei jedan socio-ekonomski značaj. Hernijacija lumbalnog intervertebralnogdiskusa može pritiskati spinalne nerve i uzrokovati bol, slabost, otupjelosti trnjenje nogu, što se naziva išijalgijom. Ona je jedan od najčešćih razlogahirurške intervencije lumbalnog segmenta kičmenog stuba.Metode. Prospektivnom studijom je obuhvaćeno 35 ispitanika, 22 muškarcai 13 žena, prosječne starosti od 47 godina. Svi ispitanici su operativno liječeniod lumbalne diskus hernije. Prvu postoperativnu rehabilitaciju uz učešćebalneofaktora svi su sproveli prema istom, ranije ustanovljenom, terapijskomprotokolu. Analizirani su podaci o starosti, polu, zanimanju, vremenu od operacijedo rehabilitacije. Procjena posture, pokretljivost lumbalnog segmenta,Lazarević-Lasegue znak i mišićna snaga donjih ekstremiteta su evidentirani iupoređeni prije početka i nakon završetka rehabilitacije, a vizuelna analognaskala bola i preoperativno.Rezultati. Prosječno vrijeme od operacije do početka balneorehabilitacijeiznosilo je 2,26 ± 1,5 mjeseci, a trajanje balneorehabilitacije prosječno 19 dana.Prosječna ocjena na skali bola prije operacije iznosila je 9,09, prije početkabalneoterapije 4,11 nakon završetka balneoterapije 1,86, a razlike su statističkiznačajne (Fr=70,00; p<0,01). Prosječna vrijednost pokreta po Schober-u prijerehabilitacije bila je 1,97, dok je nakon rehabilitacije iznosila 3,14. Prosječnaocjena grube mišićne snage donjih ekstremiteta metodom manuelnog testiranjaiznosila je 3,9 prije, a 4,4 nakon primjene balneorehabilitacije (Z=3,638; p<0,01).Zaključak. Potvrđeno je da primjenjeni terapijski protokol smanjuje bol iuvećava funkcionalni kapacitet lumbalnog segmenta kičmenog stuba kodpostdiskotomnog sindroma

Muscle strength measurement of pelvic floor in women by vaginal dynamometer

Introduction The pelvic floor is made of a mutually connected system that consists of muscles, connecting tissue and nerve components. Damage to any of these elements creates dysfunction which is exerted through stress, urinary incontinence, prolapse of genital organs and faecal incontinence. Objective The primary aim of this study was to present the possibility of objective assessment of pelvic floor muscle force in healthy and sick women using a newly designed instrument, the vaginal dynamometer, as well as to establish the correlation between the values of pelvic floor muscle force obtained by the vaginal dynamometer and digital palpation method. Methods The study included 90 female patients, age 20-58 years. One group of respondents was made of healthy women (who gave birth, and those who have not given birth), while the other one consisted of sick women (who suffered from incontinence or prolapse of genital organs, operated on or not). The pelvic floor muscle strength of every woman was measured with a newly-constructed device for measuring and monitoring of the pelvic floor muscle force in women, the vaginal dynamometer. Then it was compared with the valid clinical digital palpation (palpation with two fingers) based on the scale for measuring muscle contractions with the digital palpation - the digital pelvic assessment rating scale. The vaginal dynamometer consists of a redesigned speculum which is inserted into the vagina and a sensor for measuring the force. Results Statistically significant linear correlation was found in the values of the measured muscle force with the vaginal dynamometer and ratings produced by digital palpation (r=0.92; p&lt;0.001). Mean value of the muscle force of the healthy women measured by the vaginal dynamometer was 1.44±0.38 daN and that value of the sick women was 0.78±0.31 daN (t=8.89 for df=88; p&lt;0.001). Mean value of the ratings produced by digital palpation in healthy women was 4.10 (95% of trust limits 3.83- 4.37), while the value in sick women was 2.41 (95% of trust limits 2.10-4.16) (Z=-6.38; p&lt;0.001). Conclusion The vaginal dynamometer has been presented as an attempt to overcome the limitations of the previously presented techniques for muscle force measurement. The application of the vaginal dynamometer in clinical practice makes objective and numerical assessment of pelvic floor muscle force possible, independent of the subjective assessment of the examiner. The usage of this instrument enables not only the diagnostics of women's pelvic floor muscle problem, but also the objective monitoring of rehabilitation gynecological medicine results

Physical therapy in the treatment of stress urinary incontinence

Introduction. Stress urinary incontinence (SUI) is an involuntary release of urine through the urethra during the increase of abdominal pressure in the absence of m. detrusor contraction. The exercise of pelvic floor muscles is recommended as the first line of cure. It is the least invasive and the only method without any undesirable side effects, which leads to either improvement or complete cure of SUI in 80-85% of cases. Objective. The aim of this study was to establish whether the strengthening of pelvic floor muscles using proprioceptive neural facilitation (PNF) spiral dynamic technique was more efficient in comparison to classical Kegel exercise. Methods. The research was carried out at the Centre for Physical Medicine and Rehabilitation, Clinical Centre Kragujevac. Sixty-six female patients with the symptoms of SUI were monitored in the period of two years. Thirty-four patients did pelvic floor muscle exercises twice a day, in the morning and in the evening, with 15-20 contractions. Thirty-two patients used PNF spiral dynamic technique for strengthening pelvic floor muscles. The patients who used the spiral dynamic technique also did some exercises from the program; they exercised twice a day, in the morning and in the evening, following the prescribed schedule. Treatment outcome was assessed by measuring the pelvic floor muscles by a vaginal dynamometer. Results. The values of the pelvic floor muscle force that were measured using the vaginal dynamometer in both examined groups (PNF spiral dynamic technique or Kegel exercise) were statistically significantly higher after the implemented exercise program (t-test; p=0.000). No statistically significant difference in pelvic floor muscle values was found between the patients who applied PNF spiral dynamic technique and those who did Kegel exercise either before or after the exercise (two-factor analysis of variance with repeated measurements, factor of exercise type; p=0.899). Conclusion. Strengthening of pelvic floor muscles by exercises results in a significant increase of pelvic floor muscle strength and reduction of SUI symptoms, regardless of the used exercise program, PNF spiral dynamic technique or Kegel exercise program

Impact of climate conditions on hospital admissions for subcategories of cardiovascular diseases

Background: The aim of this study has been to examine the association between climate conditions (CC) and hospital admissions for the subcategories of cardiovascular diseases (CVD), according to patients’ age. Material and Methods: From January 2010 through December 2011, the daily number of hospital admissions for angina pectoris (AP), essential hypertension (EH), acute myocardial infarction (AMI) and ischemic heart diseases (IHD) for adults (19–64 years old) and the elderly (≥ 65 years old), as well as for the CC (N = 728 days) was collected for multivariate Poisson regression analysis, confounding with season and weekends. The results were expressed by using the relative risk with the corresponding 95% confidence interval. Results: The risk for the AMI among the adults and the elderly is significantly higher for 41.8% and 38.9%, respectively on the days with lower ambient temperature and lesser for 32.7% and 29.8%, respectively on the days with lower air pressure values. The risk for the IHD among the elderly is significantly higher on the days with lower ambient temperature and lower relative humidity for 50.6% and 37.4%, respectively. Conclusions: Our findings explain how the CC and subcategories of CVD are associated, which could be used for adequate public awareness of the risk for hospitalization due to climate conditions. Med Pr 2017;68(2):189–19

Cartilage Oligomeric Matrix Protein - inflammation biomarker in knee osteoarthritis

Chondrocytes and synovial cells synthesize Cartilage Oligomeric Matrix Protein (COMP) when activated by proinflammatory cytokines. The aim of this study was to analyze and compare ultrasound parameters of joint inflammation, effusion and synovitis with the levels of COMP in the serum of patients with primary osteoarthritis. Ultrasound was done and the concentration of COMP (ng/mL was examined in 88 patients. 75% of patients had effusion (size 10.13±4.35 mm), 62.5% had effusion in lateral recessus (LR), 28.4% (size 8.53±2.27 mm) in suprapatelar (SR), and 27.3% (size 11.38±4.44 mm) in medial (MR). 67% of patients had synovitis size 4.84±3.57 mm in SR, 3.15±1.86 mm in MR; and 6.09±2.80 mm in LR. 17.0% of patients had nodular type of synovitis, 30.7% had diffusive, and 19.3% nodular – diffusive. There was a significant link between the size of synovitis and effusion in SR (r=0.966, p=0.000), MR (r=0.812, p=0.009) and LR (r=0.886, p=0.003). The median of COMP concentration was 54 (44.5-58) ng/mL in patients without effusion. In those with effusion it was 57 (48.75-64.25) ng/mL (p=0.030). Without synovitis it was 52 (45.5-58) ng/mL, with synovitis 58 (50-66) ng/mL, (p=0.006), diffusion type synovitis 60 (50-67) ng/mL, nodular 57 (50-62) ng/mL, nodular-diffusion 54 (44.5-66.5) ng/mL (p=0.014). With longer osteophytes the median of COMP was 56 (48-64) ng/mL, with shorter osteophytes 55 (46.5-59) ng/mL (p=0.000). Cartilage oligomeric matrix protein has a moderate significance in the assessment of disturbance of the metabolism of synovial and cartilage tissue in patients with knee osteoarthritis (sensitivity=59%; specificity=50%; cut off=53.5 ng/mL)

Living unrelated donor kidney transplantation: A fourteen-year experience

Background. In countries without a national organization for retrieval and distribution of organs of the deceased donors, problem of organ shortage is still not resolved. In order to increase the number of kidney transplantations we started with the program of living unrelated - spousal donors. The aim of this study was to compare treatment outcome and renal graft function in patients receiving the graft from spousal and those receiving ghe graft from living related donors. Method. We retrospectively identified 14 patients who received renal allograft from spousal donors between 1996 and 2009 (group I). The control group consisted of 14 patients who got graft from related donor retrieved from the database and matched than with respect to sex, age, kidney disease, immunological and viral pretransplant status, the initial method of the end stage renal disease treatment and ABO compatibility. In the follow-up period of 41 ± 38 months we recorded immunosuppressive therapy, surgical complications, episodes of acute rejection, CMV infection and graft function, assessed by serum creatinine levels at the beginning and in the end of the follow-up period. All patients had pretransplant negative cross-match. In ABO incompatible patients pretransplant isoagglutinine titer was zero. Results. The patients with a spousal donor had worse HLA matching. There were no significant differences between the groups in surgical, infective, immunological complications and graft function. Two patients from the group I returned to hemodialysis after 82 and 22 months due to serious comorbidities. Conclusion. In spite of the worse HLA matching, graft survival and function of renal grafts from spousal donors were as good as those retrieved from related donors