Search results

1

Results of the Treatment of Major, Complex Hand Injuries

100%

Żyluk A., Janowski P.

Polish Journal of Surgery

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2011

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vol. 83

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issue 2

87-94

EN

Complex hand injuries are associated with serious consequences including long period off-work, permanent disability, inability to return to original profession or to work at all. As these injuries are common, they create considerable economical consequences and, therefore, it is desirable their treatment would be as perfect as possible to reduce potential loss of function.The aim of the study was analysis of the structure of complex, multi-structural hand injuries and evaluation of the outcomes of the treatment of these injuries in both medical (recovery of function) and economical (period of inability to work and costs of medical care) aspects.Material and methods. The study presents the results of treatment of 78 patients suffered from severe, major hand injuries, involving damage of at least two of four anatomical structures within the hand or wrist (bones, tendons, arteries or nerves) as well as severe injury involving at least two digits. Functional results were assessed at a mean of 10 months after the accident. Tendons were repaired in all 42 patients, bones were fixed in 29 (69%), nerves were repaired in 21 (50%), arteries in 14 (33%) and in two patients skin defect was covered by the flap (one local and one groin flap).Results. Total active motion of affected digits amounted 2/3 of normative active motion of the healthy digits and total grip strength approximated half of the grip strength of the unaffected hand. In patients with nerve injuries, a satisfactory recovery of sensation in the affected digits was obtained. Dexterity of the hand in daily activity was scored 30 points in DASH scale. Injury-related duration of sick leave in 31 patients worked at the time of the accident amounted 4.4 months in average (range 1-12). A total of 27 subjects (87% of worked) returned to work: 24 to their previous profession and three had to qualify for a new job. Total hospital costs of the treatment in the analysed group amounted a mean of 2600 PLN.Conclusion. The outcomes of the treatment of major hand injuries achieved in our institution over the period of the one year were satisfactory, considering their severity and complexity. These results, in our mind, show clearly advantages coming from an existence of qualified service for hand injuries.

2

The relationship between blood pressure variability and outcome in acute ischemic stroke

100%

Kowalczyk K., Gąsecki D.

European Journal of Translational and Clinical Medicine

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2019

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vol. 2

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issue 2

61-70

EN

Stroke is the second most common cause of mortality. Ischemic stroke is approximately 10 times more common than haemorrhagic stroke. The strongest risk factor for ischemic stroke is hypertension; thus, reduction of blood pressure decreases the risk of ischemic stroke. However, the prognostic importance of blood pressure after is unclear. The problem is even more complex considering blood pressure variability, i.e. continuous changes of blood pressure values. The aim of this review is to discuss very short-term, short-term, mid-term, and long-term blood pressure variability in the context of clinical outcome in patients after acute ischemic stroke.

3

The relationship between blood pressure variability and outcome in acute ischemic stroke

100%

Kowalczyk K., Gąsecki D.

European Journal of Translational and Clinical Medicine

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2020

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vol. 2

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issue 2

61-70

EN

Stroke is the second most common cause of mortality. Ischemic stroke is approximately 10 times more common than haemorrhagic stroke. The strongest risk factor for ischemic stroke is hypertension; thus, reduction of blood pressure decreases the risk of ischemic stroke. However, the prognostic importance of blood pressure after is unclear. The problem is even more complex considering blood pressure variability, i.e. continuous changes of blood pressure values. The aim of this review is to discuss very short-term, short-term, mid-term, and long-term blood pressure variability in the context of clinical outcome in patients after acute ischemic stroke.

4

Osteosynthesis of Common Acetabular Fractures Operated on Through a Single Posterior (Kocher-Langenbeck) Approach with or without Trochanteric Flip Osteotomy. A Case Series

88%

Manzoor Q. W., Sultan A., Mir B. A.

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EN

Background. The Kocher-Langenbeck approach is recommended in the majority of common posterior acetabular injuries. Trochanteric osteotomy can be used to extend the exposure of the Kocher-Langenbeck approach superiorly and anteriorly. We evaluated the functional outcome of common acetabular fractures operated on through the Kocher-Langenbeck approach with or without trochanteric flip osteotomy. Material and methods. This prospective study enrolled 42 patients with posterior wall, posterior column, transverse, posterior wall with posterior column, transverse with posterior wall and both column acetabular fractures. The Kocher-Langenbeck approach was used in 35 patients and trochanteric flip osteotomy was done in 7 patients. The radiological outcome was evaluated by Matta’s criteria and the functional outcome was evaluated using modified Merle d'Aubigné and Postel criteria. Results. D’Aubigne Postel scores at the final follow-up were excellent in 12 patients, good in 18, fair in 8 and poor in 4. Thirty-seven patients had congruent reduction (anatomical in 29, imperfect in 8) and 5 patients had non-congruent reduction on radiographs as per Matta’s criteria. Radiographic congruity (88.09%, 37 out of 42 cases) correlated fairly well with the functional outcome (excellent or good functional outcome in 71.4%, 30 out of 42 cases). The complications included traumatic nerve palsy (3 cases), iatrogenic nerve palsy (2 cases), deep venous thrombosis (2 cases), wound infection (3 cases), non-congruent reduction (5 cases), 8 cases of osteoarthritis of hip, 2 cases of avascular necrosis of femoral head and 3 cases of heterotrophic ossification. Conclusions. 1. Surgical treatment of common acetabular fractures with major posterior involvement can be attempted via a single posterior approach (Kocher-Langenbeck with or without trochanteric flip osteotomy) and leads to good-to-excellent results in a majority of the cases. 2. It is superior to conservative management, which has been found to be accompanied by a much higher rate of complications. 3. A thorough study of the pre-operative radiographs, Judet’s views and 3D-reconstructed CT images helps in classifying the fracture and thereby assigning or not assigning it for the posterior approach.

5

CORRELATION OF COMPUTED TOMOGRAPHY AND INTRAOPERATIVE FINDINGS WITH CLINICAL SYMPTOMS IN HEAD TRAUMA PATIENTS

88%

Saiediborojeni H., Hemmatpour B., Akrami M., Mahdavikian S., Saiediborojeni S., Mahvar T.

Acta Neuropsychologica

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2021

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vol. 19(4)

491-500

EN

Hematoma in different parts of the brain is one of the most important complications of head injury and is associated with high mortality and morbidity rate. The aim of this study was evaluation of the relationship between Computed Tomography (CT) and intraoperative findings with clinical symptoms in head trauma patients. In this study 95 patients with cerebral hemorrhage due to head trauma, referred to Taleghani Hospital in Kermanshah were studied. After an initial clinical examination, the level of consciousness determined according to the Glasgow Coma Scale (GCS) was recorded. All patients underwent brain CT scan and findings were recorded, including size and location of the hematoma. Patients in all treatment such as surgical procedures under the supervision, and the information on their status was recorded until discharge or death. It was found that most patients (38%) were between 40-20 years: 73% of patients were male, while 27% were female. The outcome of 35 patients (35.4%) were normal, 12 patients (12.3%) had moderate disability, 9 patients (9.2%) had severe disability, 11 patients (10.8%) vegetative state and 31 patients (32.3%) died. There was a significant association between location of the hematoma and hematoma in CT scan and outcome of patients with cerebral hemorrhage caused by trauma (P<0.05). We also found a significant association between size of the hematoma and midline shift in CT scan with outcome of patients with cerebral hemorrhage caused by trauma (P<0.05). The prognosis of patients with traumatic brain injury depends on location of the hematoma; volume of hematoma, midline shift in CT scan and length of trauma to surgery more than 4 hours.

6

Postoperative Hydrocele after Varicelectomy in Adolescents and its Prophylaxis

88%

Olejniczak D., Samolewicz E., Krupińska E., Taczalska A.

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2009

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vol. 81

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issue 3

123-128

EN

Postoperative hydrocele (PH) is the most common and important complication of surgical treatment of varicocele. It may form many years after procedure performed in adolescent boys. Among procedure modifications aiming at prevention of PH the authors describe formation of a ‘window’ in tunica vaginalis and lymphatic vessels sparing.The aim of the study was determination of true PH occurrence in long term results and evaluation of implemented modifications of surgical treatment aimed at decreasing the occurrence of this complication.Material and methods. The analysis comprised 289 boys operated using the Palomo method between 1991-2007. Initially no modification aiming at PH prevention was used, between 2003-2005 a ‘window’ was created in tunica vaginalis and since 2005 the standard has become dyeing of the lymphatic vessels which enabled sparing of these vessels during surgery. We evaluated the frequency of PH formation basing on direct postoperative and long term results in our operated patients.Results. Out-patient records of 289 boys who had undergone primary varicelectomy between 1999-2007 were retrospectively reviewed. In the group of 237 patients operated using the standard method PH was diagnosed in 26 cases (10.98%). The results were not improved by introduction of a modification - creation of a ‘window’ in tunica vaginalis. Hydrocele formed in 4 out of 27 patients (14.82%). In 25 boys treated with modified method - lymphatic vessels dyeing and sparing - in early postoperative period there were no cases of PH. The analysis of 122 adult men treated in childhood, who had been followed for on average 8 years and 8 months after surgery, showed that the frequency of PH after standard Palomo procedure without any preventive modifications was 27.9% (34 out of 122 operated cases).Conclusions. 1. Postoperative hydrocele is the most common complication of surgical treatment of varicocele, however comparison of results from different centres requires uniform diagnostic criteria. 2. Early evaluation of this complication after procedures without preventive modifications may not be reliable, as PH may form many years after operation (11% based on records from early postoperative period, 27.8% based on long term results). 3. Among the modifications aimed at prevention of PH formation lymphatic vessels sparing seems most effective (in 25 patients operated using this method no PH in early postoperative period was seen), however long term results must be taken into account.

7

Endoprotezoplastyka odwrócona w artrozie stawu ramiennego – ocena wyników

63%

Porwoł A., Bereza P., Marszałek W., Kusz D.

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vol. 24(4)

239-249

EN

Background. The aging structure of society results in a growing need for treatment of shoulder osteoarthritis. Reverse shoulder arthroplasty (RSA) has been developed to improve the motor function and strength of the shoulder joint without increasing the risk of dislocation. The aim of the study was to assess the change in quality of life and functional assessment of the shoulder joint after RSA in patients with osteoarthritis, based on the Oxford Shoulder Score (OSS) and an assessment of joint mobility parameters. Material and methods. A total of 10 patients were admitted to our centre for shoulder arthroplasty between August 2020 and October 2021. The assessment of the degenerative changes was based on the Walch classification and the Samelson & Prieto classification. The OSS questionnaire was used to assess function of the affected shoulder joint and pain in each patient. The range of motion in the shoulder joint was assessed in the pre- and postoperative period. A follow-up examination was performed approximately 6 months after surgery. Results. Analysis of the OSS scores revealed a mean value of 46 points preoperatively and 25 points postoperatively. The OSS scores six months after the procedure were an average of 20.5 points lower. A statistically significant improvement was noted in shoulder flexion (mean 37˚), abduction (42˚), external rotation (34˚), and internal rotation (5˚)(p<0.05). Conclusion. Each patient reported reduced pain and demonstrated an increased range of motion in the affected shoulder joint and functional improvement.

PL

Wstęp. Starzejąca się struktura społeczeństwa powoduje rosnąca potrzebę leczenia choroby zwyrodnieniowej z wykorzystaniem technik endoprotezoplastyki stawu ramiennego. Endoprotezoplastyka odwrócona powstała by usprawnić motorykę i siłę stawu ramiennego u chorych bez jednoczesnego zwiększenia ryzyka zwichnięć. Celem badania jest ocena zmiany jakości życia i ocena funkcjonalna stawu ramiennego po operacji endoprotezoplastyki odwróconej stawu ramiennego, u pacjentów z chorobą zwyrodnieniową, w oparciu o wykorzystanie skali Oxford Shoulder Score (OSS) oraz ocenę parametrów ruchomości stawu. Materiał i metody. W okresie od sierpnia 2020 do października 2021 przyjęto do oddziału 10 chorych w trybie planowym do endoprotezoplastyki stawu ramiennego. Ocenę zmian zwyrodnieniowych przeprowadzono na podstawie klasyfikacji Walcha oraz klasyfikacji Samelson & Prieto. U każdego pacjenta wykonano ocenę funkcji chorego stawu ramiennego oraz dolegliwości bólowych, w oparciu o ankietę OSS. W badaniu określono zakres ruchu w stawie ramiennym w okresie przed- i pooperacyjnym. Badanie kontrolne wykonywano po około 6 miesiącach od daty zabiegu. Wyniki. Analiza ocen skali OSS wykazała uzyskanie średniej wartości 46 punktów w okresie przed operacją oraz 25 punktów po operacji. Chorzy uzyskiwali średnio o 20,5 punktu mniej w formularzu OSS pół roku po zabiegu. Uzyskano statystycznie znamienną poprawę w zakresie zgięcia w stawie ramiennym, które średnio wynosi 37˚, odwodzenie 42˚, rotacja zewnętrzna 34˚, a rotacja wewnętrzna 5˚(p<0,05). Wniosek. Każdy z operowanych chorych uzyskał istotne statystycznie zmniejszenie dolegliwości bólowych, zwiększenie funkcjonalności stawu oraz zwiększenie zakresu ruchomości stawu.

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Profil ekspresji genów w gwiaździakach włosowatokomórkowych wieku dziecięcego w odniesieniu do lokalizacji, obrazu radiologiczno‑morfologicznego i przebiegu klinicznego choroby

51%

Zakrzewska M.

Aktualności Neurologiczne

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2011

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vol. 11

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issue 3

135-198

EN

Pilocytic astrocytoma (PA) is the most common type of brain tumour in paediatric population connected with favourable prognosis although in numbered cases recurrence or dissemination could be observed. PA accounts for 30% of all brain tumours occurring in children. The tumours affect various anatomical structures and show different radiological appearance. Genetics of this tumour as well as the plausible correlations between molecular profile and clinical course of the disease and/or radiological features are still undefined. The purpose of our research was the identification of gene expression profiles related to localization and radiological features of pilocytic astrocytomas and clinical course of the disease. Eighty six children with PAs, operated on in the Department of Neurosurgery, Polish Mother’s Memorial Hospital Research Institute, were included in this study. The group was comprised of 55 males and 31 females. The mean age of patients at the time of diagnosis was 7 years (ranging from 1 to 17 years). All specimens were diagnosed at the Department of Molecular Pathology and Neuropathology Medical University of Lodz, according to the WHO criteria. The analysis was done by high density oligonucleotide microarrays (GeneChip Human Genome U133 Plus 2.0) in 50 snap‑frozen tissue samples diversified in terms of localization (28 cerebellar tumours, 11 optic tracts and hypothalamic tumours, 9 hemispheric tumours, 2 brain stem tumours), radiological appearance (27 solid or mainly solid tumours, 10 cystic tumours where the mural nodule and the cyst wall were enhanced, 8 cystic tumours where only the mural nodule was enhanced, 5 largely necrotic tumours) and clinical course (5 cases of progressive disease after subtotal resection, 2 cases connected with neurofibromatosis type 1). Bioinformatic analyses with using Bioconductor packages were done after normalization of data with using GC‑RMA algorithm. Gene expression profile of pilocytic astrocytomas highly depends on the tumour localization. This correlation reach statistical significance (p=0.001). Eight hundred sixty‑two probesets differentiated tumours of different localization with high significance of global test. Most prominent differences were noted for IRX2, PAX3, CXCL14, LHX2, SIX6, CNTN1 and SIX1 genes. Analysis of the genes differentiating between radiological features showed much weaker transcriptome differences, with the borderline significance in the global test of association (p=0.88). No genes showed significant association with the tendency to progression in univariate analysis (p=0.83). The results of microarray analysis were confirmed by QRT‑PCR. In the conclusion we showed that gene expression profile in pilocytic astrocytomas is connected with tumour localization and such relationship suggest different origin of PA arising within various anatomical brain structures. Morphological and radiological features as well as clinical course of disease seem not to be associated with different gene expression pattern.

PL

Gwiaździak włosowatokomórkowy (pilocytic astrocytoma, PA) jest najczęstszym nowotworem mózgu występującym u dzieci, u których stanowi około 30% wszystkich nowotworów ośrodkowego układu nerwowego. Biologia molekularna tego nowotworu, pomimo jego częstego występowania w populacji dziecięcej, nie została dotąd wystarczająco poznana, a ewentualnego związku pomiędzy obecnością zaburzeń molekularnych a parametrami klinicznymi nie zdefiniowano na poziomie pozwalającym wykorzystać wyniki badań genetycznych w sferze działań klinicznych. Celem projektu było ustalenie profili ekspresji genów różnicujących gwiaździaka włosowatokomórkowego wieku dziecięcego w zależności od jego umiejscowienia, obrazu radiologiczno‑morfologicznego oraz przebiegu klinicznego choroby. Do badań zakwalifikowano nowotworowy materiał tkankowy pochodzący od 86 dzieci (55 chłopców, 31 dziewcząt) w wieku od 1 do 17 lat (mediana 7 lat). Wszystkie przypadki zostały zdiagnozowane w Zakładzie Patologii Molekularnej i Neuropatologii Uniwersytetu Medycznego w Łodzi w oparciu o kryteria bieżącej klasyfikacji nowotworów ośrodkowego układu nerwowego według WHO. Badania mające na celu identyfikację istotnych biologicznie odchyleń w ekspresji genów przeprowadzono przy użyciu mikromacierzy wysokiej gęstości Human Genome U133 Plus 2.0 (Affymetrix) w 50 przypadkach gwiaździaków włosowatokomórkowych. Badana grupa była zróżnicowana pod względem lokalizacji (28 nowotworów móżdżku i komory IV, 11 nowotworów dróg wzrokowych i podwzgórza, 9 nowotworów półkul mózgu, 2 nowotwory pnia mózgu), obrazu radiologiczno‑morfologicznego (27 nowotworów litych, 10 nowotworów torbielowatych, w których wzmocnieniu kontrastowemu ulegały ściana torbieli i guzek przyścienny, 8 nowotworów torbielowatych z guzkiem przyściennym, w których wzmocnieniu kontrastowemu ulegał tylko guzek przyścienny, 5 nowotworów z obecnymi cechami martwicy centralnej) i przebiegu klinicznego choroby (5 przypadków z cechami klinicznymi progresji choroby po resekcji subtotalnej, 2 przypadki rozwijające się w przebiegu neurofibromatozy typu 1.). Po normalizacji wyników przy użyciu algorytmu GC‑RMA przeprowadzono analizy bioinformatyczne wykorzystujące przede wszystkim pakiet Bioconductor. Wyselekcjonowano 862 geny różnicujące gwiaździaki włosowatokomórkowe pod względem umiejscowienia anatomicznego i wykazano obecność istotnej zależności statystycznej pomiędzy profilem ekspresji genów w odniesieniu do lokalizacji zmiany (p=0,001). Na podstawie uzyskanych wyników dokonano wyboru genów będących markerami molekularnymi dla nowotworów rozwijających się w poszczególnych lokalizacjach (IRX2, PAX3, CXCL14, LHX2, SIX6, CNTN1, SIX1). Nie wykazano możliwości zróżnicowania badanej grupy w zależności od obrazu radiologiczno‑morfologicznego. Geny najlepiej różnicujące badaną grupę cechowały się małą amplitudą zmian i brakiem znamienności statystycznej (p=0,88). Podobnie progresja choroby nie była związana z profilem ekspresji genów (p=0,83). Walidację uzyskanych wyników przeprowadzono w oparciu o QRT‑PCR. Przeprowadzone analizy pozwoliły stwierdzić, że gwiaździakiwłosowatokomórkowe w zależności od lokalizacji anatomicznej posiadają charakterystyczny profil ekspresji genów, sugerujący ich różne pochodzenie. Z kolei obraz radiologiczno‑morfologiczny oraz przebieg kliniczny choroby nie mają związku z całkowitym profilem ekspresji genów.

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Results of the Treatment of Major, Complex Hand Injuries

The relationship between blood pressure variability and outcome in acute ischemic stroke

The relationship between blood pressure variability and outcome in acute ischemic stroke

Osteosynthesis of Common Acetabular Fractures Operated on Through a Single Posterior (Kocher-Langenbeck) Approach with or without Trochanteric Flip Osteotomy. A Case Series

CORRELATION OF COMPUTED TOMOGRAPHY AND INTRAOPERATIVE FINDINGS WITH CLINICAL SYMPTOMS IN HEAD TRAUMA PATIENTS

Postoperative Hydrocele after Varicelectomy in Adolescents and its Prophylaxis

Endoprotezoplastyka odwrócona w artrozie stawu ramiennego – ocena wyników

Profil ekspresji genów w gwiaździakach włosowatokomórkowych wieku dziecięcego w odniesieniu do lokalizacji, obrazu radiologiczno‑morfologicznego i przebiegu klinicznego choroby