Arthroplasty of the knee six months after surgery, the return to fitness

Degenerative joint disease (osteoarthritis) is a chronic disorder of the musculoskeletal system, which significantly reduces the efficiency of movement and daily functioning difficult. The last twenty years is a huge progress in the diagnosis and treatment of degenerative changes in the knee joint. Currently knee replacement is a fundamental activity in patients with large destructive changes in the joint. Studies carried out in the clinic Trauma Surgery at the University Teaching Hospital in Wroclaw, ul. Borowski group of 105 patients. In this study, we observed that there was an improvement of quality of life after surgery, knee replacement, especially in people at a younger age. The pain persisted completely, but reduced in intensity. Women often suffer from arthritis and achieve better results on the knee. It was also shown that younger people better cope with the activities of daily living and have less pain from the knee joints. This suggests that a return to efficiency and improve the functioning of younger people should be achieved in a shorter time than adults, whose efficiency is further limited by the patient's age

Zastosowanie elastografii w przewidywaniu porodu przedwczesnego u pacjentek z krótką szyjką macicy stwierdzoną między 18-22 tygodniem ciąży: prospektywne badanie obserwacyjne

Objectives: The aim of the study was to estimate the potential value of elastographic evaluation of the internal cervical os at 18-22 weeks of pregnancy in patients with short cervical length for prediction of preterm delivery (PTD). Material and methods: This prospective observational study included 109 patients with cervical length of ≤25 mm at 18-22 weeks scan. Stiffness of the internal cervical os was assessed by elastography. Elastographic assessment of the internal os was performed using a color map: red (soft), yellow (medium soft), blue (medium hard), and purple (hard). If two colors were visible in the region of the internal os, the softer option was noted. The following outcome measures were analyzed: percentage of PTDs in various categories of elastographic cervical assessment, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of elastography in predicting PTDs. Additionally, ROC curves were constructed for elastography and cervical length for predicting PTDs. Results: Forty-five cases of PTDs (Cel: Ocena znaczenia elastograficznej oceny ujścia wewnętrznego szyjki macicy w przewidywaniu porodu przedwczesnego (PTD) u pacjentek z krótką szyjką macicy stwierdzoną w 18-22 tygodniu ciąży. Materiał i metody: Prospektywne badanie obserwacyjne obejmujące 109 pacjentek z długością szyjki macicy ≤25 mm stwierdzoną w 18-22 tygodniu ciąży. Elastograficznie oceniano twardość ujścia wewnętrznego szyjki macicy z użyciem następującej skali kolorów: czerwone (miękkie); żółte (średnio miękkie); niebieskie (średnio twarde); fioletowe (twarde). W przypadku uwidocznienia dwóch kolorów w okolicy ujścia wewnętrznego wybierano opcję bardziej miękką. Analizowano następujące zmienne: odsetek PTD w poszczególnych kategoriach twardości ujścia wewnętrznego oraz czułość, swoistość, ujemną i dodatnią wartość predykcyjną (NPV i PPV) elastografii w przewidywaniu PTD. Ponadto wyznaczono krzywe ROC dla elastografii i długości szyjki macicy w przewidywaniu PTD. Wyniki: W badanej populacji wystąpiło 45 PTD

Extensive postpartum urinary retention successfully treated with clean intermittent catheterization

We present a case of extensive urine retention after vaginal delivery. Postpartum urinary retention occurs in 0.7 to 0.9% of vaginal deliveries. In the literature, mediolateral episiotomy, epidural analgesia, perineal lacerations, macrosomic birth and prolonged 2nd stage of labor are suggested as risk factors for postpartum urine retention.          

The role of endocrine factors in the pathogenesis of spontaneous abortion after IVF-ET

Odpowiedź na pytanie, czy ryzyko poronienia samoistnego po IVF-ET jest wyższe niż po poczęciu naturalnym, nie jest łatwa. Wpływa na to fakt, iż rozwój wczesnych ciąż po IVF-ET jest zdecydowanie bardziej intensywnie monitorowany, co skutkuje w tej grupie pacjentek bardzo precyzyjnym określeniem częstości poronień, również subklinicznych. Przeważa jednak opinia, że ryzyko względne poronienia samoistnego po IVF-ET jest znamiennie większe aniżeli po poczęciu naturalnym.There is large body of evidence to show that the risk of early pregnancy loss is higher after IVF-ET than after natural conception. Several hypotheses have been proposed to explain this phenomenon. One of the possible etiopathogetic factors is the patient’s age which is significantly higher in women undergoing IVF than in the general population of naturally conceiving women. Immunologic factors have also been suggested. It seems that procedures like ICSI do not increase the risk of spontaneous abortion (SAB) after IVF-ET. Moreover, the proportion of products of conception with chromosomal aberration in cases of SAB following ICSI procedure is not elevated. Many authors point to the problem of iatrogenic luteal defect after IVF-ET. The use of luteal support after IVF-ET is widely recommended. Interestingly, firm evidence is lacking regarding the efficacy of progestagen or hCG supplementation on the risk of SAB after IVF-ET. However the issue of the effectiveness of progesterone support in decreasing the risk of SAB after ART procedures is far from being conclusively resolved – it deserves well planned, randomized studied to be performed

Ascites Index — a novel technique to evaluate ascites in ovarian hyperstimulation syndrome: a concept-proof study

 Objectives: Controlled ovarian hyperstimulation is an important step in infertility treatment. In some cases, however, ovar­ian hyperstimulation syndrome (OHSS) can occur. In its severe forms, ascites is likely to develop, associated with dyspnea. The aim of this study was to explore the usefulness of Ascites Index (AsI), a new tool for quantitative determination of ascites in patients with OHSS, to obtain data for planning further trials. Material and methods: Twelve patients with OHSS and ascites were included in the study. All patients were admitted to the hospital because of abdominal pain and dyspnea due to increasing ascites. Ultrasound measurements of ascites extent were performed in four external quadrants of the abdomen. Pockets of free fluid were measured. The obtained values were totaled, forming the Ascites Index (AsI), similarly to the amniotic fluid index. Because of dyspnea, paracentesis was performed in all cases. Results: Median AsI at which patients reported dyspnea was 29.0 cm (range 21.6–38.6 cm). At AsI values less than 21.6 cm, no dyspnea was observed in any of the 12 studied patients. To avoid complications, 2000 mL of ascitic fluid was collected in each patient. After paracentesis, range of AsI decreased to 12.1–14.5 cm. Conclusions: The proposed AsI seems to be a promising tool for estimating and monitoring the ascites extent in OHSS. It can be estimated using basic ultrasound equipment. AsI requires further studies for standardization and transferability to other causes of ascites

Embolizacja tętnic macicznych – zagadnienia kliniczne

The aim of the study was to present clinical issues concerning uterine artery embolization (UAE) in women with uterine fibromas. In order to ensure high clinical efficiency of UAE and prevent subsequent complications, it is necessary to carefully select patients eligible for the procedure. Patients with intramural fibromas, who do not plan to conceive, are the best candidates for the procedure. Fibroma necrosis, with following infection, and premature ovarian failure remain to be the most common complications after UAE. UAE may cause amenorrhea and increase FSH levels, what is typical for menopause. Thus, it may be responsible for problems with conception as well as optimal development of a pregnancy. It may also cause premature, iatrogenic menopause. This complication significantly more frequently occurs in women over the age of 45 as compared to younger patients. UAE is considered as an alternative therapeutic procedure, available to women who do not desire the surgery or wish to preserve the uterus. Patients subject to this procedure should be informed about the possible side effects.Celem pracy było przedstawienie zagadnień klinicznych związanych z zabiegami embolizacji tętnic macicznych (UAE) w przypadku objawowych mięśniaków macicy. Zwrócono uwagę, że odpowiednia kwalifikacja chorych do zabiegu ma kluczowe znaczenie dla wysokiej skuteczności klinicznej oraz zapobiegania powikłaniom po UAE. Kandydatkami powinny być kobiety z objawowymi mięśniakami położonymi śródściennie, które w przyszłości nie planują zachodzić w ciążę. Przedwczesne wygasanie czynności jajników, obok martwicy mięśniaka z następową infekcją stanowi jedno z najczęstszych powikłań embolizacji. Może być przyczyną przedwczesnej, jatrogennej menopauzy oraz trudności w zajściu i donoszeniu ciąży. UAE może niekorzystnie wpłynąć na funkcję jajników, powodując czasowe lub stałe zatrzymanie miesiączki, a także typowy dla okresu menopauzy wzrost poziomu FSH. Znacznie częściej to powikłanie UAE obserwuje się u kobiet po 45 roku życia, niż młodszych. Embolizacja tętnic macicznych przeprowadzana w celu leczenia objawowych mięśniaków macicy stanowi alternatywną opcję terapeutyczną, istotną dla kobiet, które nie chcą poddawać się operacji lub pragnących zachować macicę. Chore poddawane tego typu leczeniu powinny być poinformowane o możliwych skutkach ubocznych

Genital psoriasis: a hidden multidisciplinary problem — a review of literature

Genital psoriasis is a variety of autoimmune dermatological disease — psoriasis with relapsing-remitting course, which can have an onset in all age groups. It is most often diagnosed at an advanced stage. Genital psoriasis is considered an embar­rassing condition and is often misjudged as a sexually transmitted disease or allergic reaction due to low social awareness of the disease. The manifestations of genital psoriasis may differ from typical genital dermatoses and with symptoms such as itch, erythroderma and vaginal discharge may mimic other diseases at an early stage. The diagnosis and treatment of genital psoriasis may be difficult and often requires a multidisciplinary approach. The aim of this article is to present the literature review of genital psoriasis concentrating on the clinical presentation, treatment and influence on the quality of patients’ life and sexual activity disorders

genital psoriasis a hidden multidisciplinary problem a review of literature

Genital psoriasis is a variety of autoimmune dermatological disease — psoriasis with relapsing-remitting course, which can have an onset in all age groups. It is most often diagnosed at an advanced stage. Genital psoriasis is considered an embar­rassing condition and is often misjudged as a sexually transmitted disease or allergic reaction due to low social awareness of the disease. The manifestations of genital psoriasis may differ from typical genital dermatoses and with symptoms such as itch, erythroderma and vaginal discharge may mimic other diseases at an early stage. The diagnosis and treatment of genital psoriasis may be difficult and often requires a multidisciplinary approach. The aim of this article is to present the literature review of genital psoriasis concentrating on the clinical presentation, treatment and influence on the quality of patients' life and sexual activity disorders

Neurological symptoms in hospitalised patients with COVID-19 and their association with in-hospital mortality

Objectives. To evaluate the spectrum of neurological symptoms in patients with COVID-19 during the first 14 days of hospitalisation and its association with in-hospital mortality. Material and methods. We included 200 patients with RT-PCR-confirmed COVID-19 admitted to University Hospital in Krakow, Poland. In 164 patients, a detailed questionnaire concerning neurological symptoms and signs was performed prospectively within 14 days of hospitalisation. In the remaining 36 patients, such questionnaires were completed retrospectively based on daily observations in the Department of Neurology. Results. During hospitalisation, 169 patients (84.5%) experienced neurological symptoms; the most common were: fatigue (62.5%), decreased mood (45.5%), myalgia (43.5%), and muscle weakness (42.5%). Patients who died during hospitalisation compared to the remainder were older (79 [70.5–88.5] vs. 63.5 [51–77] years, p = 0.001), and more often had decreased level of consciousness (50.0% vs. 9.3%, p < 0.001), delirium (33.3% vs. 4.4%, p < 0.001), arterial hypotension (50.0% vs. 19.6%, p = 0.005) or stroke during (18.8% vs. 3.3%, p = 0.026) or before hospitalisation (50.0% vs. 7.1, p < 0.001), whereas those who survived more often suffered from headache (42.1% vs. 0%, p = 0.012) or decreased mood (51.7% vs. 0%, p = 0.003). Conclusions. Most hospitalised patients with COVID-19 experience neurological symptoms. Decreased level of consciousness, delirium, arterial hypotension, and stroke during or before hospitalisation increase the risk of in-hospital mortality