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Zespół Aspergera u 19-letniej kobiety ze szczególnym uwzględnieniem okresu adolescencji – opis przypadku

100%
Mazur A., Chojnowska-Ćwiąkała I.
Psychiatria i Psychologia Kliniczna
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2016
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vol. 16
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issue 1
38-46
EN
The article includes a description of a 19-year-old woman diagnosed with Asperger syndrome at the age of 14. It presents the changes in the clinical picture, with specific emphasis on the period of adolescence. They were illustrated with original patient’s statements about her problems. What attracts the attention is a peculiar language which is used by the patient – childish, though at the same time marked with grandiose tendencies. This language, with its intellectual, self-centered acumen and unwavering determination, symbolically expresses her limitations and difficulties connected with taking up new developmental tasks in biological, psychological (intrapsychic) and social (interpersonal) areas in the course of adolescence. The specificity of the current, early-adult functioning of the patient is emphasised with her generally good intellectual capacity and well-established disorders in the area of social adaptation.
PL
Artykuł zawiera opis przypadku 19-letniej kobiety z zespołem Aspergera zdiagnozowanym w 14. roku życia. Przedstawiono zmiany obrazu klinicznego ze szczególnym uwzględnieniem adolescencji. Zostały one zilustrowane oryginalnymi wypowiedziami pacjentki na temat jej problemów. Uwagę zwraca osobliwy język, jakim posługuje się kobieta – infantylny, choć z zaznaczonymi tendencjami wielkościowymi. Język ten, z jego intelektualną i egocentryczną przenikliwością oraz niezachwianą determinacją, symbolicznie wyraża ograniczenia i trudności związane z podejmowaniem nowych zadań rozwojowych w obszarze biologicznym, psychologicznym (intrapsychicznym) i społecznym (interpersonalnym) w przebiegu adolescencji. Omówiono także specyfikę aktualnego, wczesnodorosłego funkcjonowania pacjentki – osoby z ogólnie dobrą wydolnością intelektualną i utrwalonymi zaburzeniami w sferze przystosowania społecznego.
2
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Analysis of the reliability of clinical examination in predicting traumatic cerebral lesions and skull fractures in patients with mild and moderate head trauma

81%
Żyluk A., Mazur A., Piotuch B., Safranow K.
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vol. 85
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issue 12
699-705
EN
The aim of the study was to assess the reliability of neurological examination and other factors in predicting traumatic cerebral lesions and skull fractures in patients with mild and moderate head trauma (GCS 10-15). Material and methods. Over a one-year period, 227 patients: 145 male and 82 female, aged a mean of 51 years who sustained mild or moderate head trauma (GSC 10-15) were examined neurologically and had performed head CT scans. The neurological examination as a whole and each finding of the neurological examination were tested as predictors of the presence of traumatic abnormalities in the head CT scan. Results. Post-traumatic lesions in head CT scan were found in 109 patients (48%): skull fractures in 66 of these and brain injuries in 94; fifty-eight patients had skull fracture combined with brain injury. Seventeen patients required neurosurgical intervention (hematoma evacuation). Abnormal neurological examination showed the highest reliability in identifying patients with brain injuries in CT (sensitivity 87%, specificity 79%). Of single findings, gait abnormalities and consciousness disturbances, present in sober patients, were the strongest predictors of cerebral lesions. Likewise, abnormal neurological examination was the best indicator of skull fractures (sensitivity 77%, specificity 63%). Gait abnormalities and “racoon eyes” present in alcohol intoxicated patients were the strongest individual predictors of skull fractures. Conclusion. Results of our study show neurological abnormalities as the most reliable (although not 100% accurate) in identifying patients who are likely to have brain injuries and/or skull fracture following head trauma. Use of clinical decision rules may reduce the number of head CT scans performed “just in a case”.
3
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Three-Year Activity Report of the Replantation Service for Amputation of the Hand in Poland

81%
Żyluk A., Jabłecki J., Romanowski L., Mazur A.
Polish Journal of Surgery
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2012
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vol. 84
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issue 11
574-581
EN
A permanent on-call service for hand amputation (Replantation Service) was established in 2010 as the initiative of the Council of Polish Society for Surgery of the Hand. It is run by three qualified hand centres in Trzebnica, Poznań and Szczecin. The aim of the study was to present a summary of the almost three-year activity of this service. Material and methods. Over this period, a total of 435 cases of total amputations, subtotal amputations and other severe injuries to the hand were referred. Of these, 290 referrals (67%) were accepted and 141 (33%) rejected. Among accepted, there were 100 total (34%) and 113 subtotal (39%) amputations; 81 patients had other, severe hand injuries, such as crush, degloving and extensive wounds involving all tissues. Results. Young and middle-age males constituted the majority of patients with the mean age of 42 years (range 2-82). The most common injury was amputation of several digits (including thumbs) in one patient - 141 cases (48%), followed by amputations from the metacarpal- to the proximal forearm level -115 (39%) and elbow/arm level - 9 cases (3%). Niniteen patients (6%) had multi-level amputation or injury of the involved extremity. Replantation of the completely amputated extremity was performed in 83 patients (28%), revascularization in 95 (32%) and in 59 (20%) primary repair of the complex injuries. In 23 cases, the repair of tissue defects was performed with flaps, mostly with greater omentum. Survival rate was of 84% for replantations and 88% for revascularizations. Conclusion. Establishing of the Replantation Service constituted a significant progress in organization of the management of the most severest upper limb injuries.
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