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1
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Diagnostic and therapeutic algorithm of proceeding in back pain disorders

100%
Krasuski M.
Medical Rehabilitation
|
2005
|
vol. 9(3)
19-25
PL
Zespoły bólowe kręgosłupa są wbrew pozorom trudne w diagnozowaniu i leczeniu. Decydują o tym niespecyficzne objawy kliniczne i czasami bardzo bogate w treści badania dodatkowe. Okazuje się też, że czasami zbyt mało mamy informacji dotyczących rzeczywistego działania leczniczego niektórych zabiegów stosowanych w fizykoterapii, stąd pojawia się problem oceny skuteczności prowadzonego leczenia. W pracy przedstawiono propozycję algorytmu diagnostyczno-leczniczego w zespołach bólowych kręgosłupa. Omówiono najistotniejsze zagadnienia związane z diagnostyką i leczeniem bólów kręgosłupa. W algorytmie zwraca się uwagę na kolejność postępowania w zależności od uzyskanych informacji dotyczących diagnostyki, a także wskazano na najczęściej stosowane zabiegi terapeutyczne. Algorytm ma ułatwić postawienie rozpoznania choroby i ograniczyć do minimum błędy wynikające z niewłaściwej diagnozy, a co za tym idzie niewłaściwego leczenia. Obserwacje kliniczne dowodzą, że zbyt często rozpoznanie zespołów bólowych kręgosłupa traktuje się ogólnikowo, nie wnikając w szczegóły dotyczące określenia chorej struktury wywołującej objawy chorobowe.
EN
Back pain is a symptom presented in a broad range of disorders. Blurred or non-specyfic clinical presentation, excessive information from laboratory tests and image techniques, numerous therapeutic options of poor efficiacy evidence, explain difficulties in diagnosing and management of a person with low back pain. According to autor’s clinical observation there is a large number of back pain patients referred to specialized treatment with unrecognized cause and character of main and accompanying disorders. The paper presents an original pattern of diagnostic and therapeutic proceeding with patient apearing with back pain. Important and often neglected aspects of adequate diagnostic and therapeutic proceeding are discussed. The pattern is based on author’s clinical experience and literature review. The algorithm defines a logical consequence of proceeding and validates base for drawing clinical conclusions for an adequate therapeutic program design. Author believes that clinical proceeding according to the presented pattern could facilitate determination of a proper diagnosis and diminish the risk of incorrect treatment consequences.
2
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Changes of ventilatory parameters in the positional training of persons after cervical spinal cord injury

63%
Tederko P., Krasuski M.
Medical Rehabilitation
|
2009
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vol. 13(1)
11-17
EN
Background: Cervical spinal cord injury (CSCI) is followed by mixed respiratory dysfunction.Purpose: Evaluation of the ventilatory parameters of CSCI patients in postures typical for positional training. Material: 51 CSCI patients in a mean age of 34.4 (SD=14.6) years; complete motor deficite (CMD) 66.6%; injury of C5 level or above – 68.6%. Control group(CG): 10 healthy volunteers. Method: Spirometry and flow-volume examination in recumbent (R), sitting (S) and vetrical 60o tilt (V) positions. Main results: Expiratory reserve volume (ERV) undergoes significant positional changes in CG (R: 1.34 L, H: 0.25 L, V: 0.79 L; p=0.02), but not in CSCI patients. Transition from R to S in CMD persons results in a significant decrease in vital capacity (VC) (from 2.45 to 1.75 L; p=0.0008); inspiratory capacity (IC) (from 2.48 to 1.41 L; p=0.0008); forced expiratory volume in 1 second (FEV1) (from 2.21 to 1.64 L; p=0.002); forced vital capacity (FVC) (from 2.55 to 1.78 L; p=0.0004). The FEV1/FVC rate does not depend on positional changes ranging from 89.7% to 93.9% of the reference values. Ventilatory parameters in the incomplete motor deficite (ICMD) group do not differ significantly between the examined body positions. Transition between R and S in the CMD group results in a significant decrease in the peak expiratory flow (PEF) (from 4.23 to 3.53 L/s) and the peak inspiratory flow (PIF) (from 3.89 to 3.43 L/s), while in ICMD the PEF increases from 4.01 to 4.39 L/s and the PIF increases from 3.66 to 4.18 L/s.Conclusions: Transition from R to S in CSCI patients results in increased restriction. CMD patients express a reduction of peak flows while in the ICMD peak flows increase after transition between R and S. Shifting from S to a 60o vertical tilt with standard trunk stabilization does not change significantly the ventilatory parameters in CSCI patients.
3
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Impact of spinal injury with neurological consequences on sexual function: Sexual dysfunctions in men

51%
Tederko P., Krasuski M., Kiwerski J.
Medical Rehabilitation
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2007
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vol. 11(4)
27-31
EN
Sexual impairment and decreased fertility constitute a part of a complex dysfunction typical for men with spinal injury with neurological consequences (SINC). Despite the progress in medical sciences and quality of care provided for disabled persons, the problem is often neglected by medical professionals and caregivers.Aim of the study: Presentation of patophysiological background and specificity of sexual dysfunction typical for men following SINC. Review of contemporary treatment modalities designed for erectile dysfunction and infertility in men after SINC.Method: Literature review, authors’ clinical experience.Results and conclusions: Specific neurological deficit with overlapping adaptation problems and depression account for erectile dysfunction in men after SINC. There is a wide range of efficient therapies addressed to patients suffering from erectile disturbances resulting from SINC. Selection of a proper therapy depends on location (level) of the lesion of a neural structure, type of deficit, functional status, presence of symptoms of autonomic dysreflexia, concomitant diseases and patient’s individual preferences. Patient’s awareness of the disability and positive attitude towards acceptance of alternative forms of sexual expressions are crucial for the therapeutic success. Ejaculation dysfunction and infertility are common among men after SINC. Application of contemporary methods of assisted reproduction may be efficient in about half of male population with SINC.
4
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Impact of spinal injury with neurological consequences on sexual function: Sexual dysfunctions in women

51%
Tederko P., Krasuski M., Kiwerski J.
Medical Rehabilitation
|
2007
|
vol. 11(4)
32-35
EN
Patophysiological background of sexual dysfunctions in women after spine injury with neurological consequePatophysiological background of sexual dysfunctions in women after spine injury with neurological consequences (SINC) is a difficult object of scientific investigations and is not as accurately described as sexual impairment in men after SINC. In particular, systematic reports on pregnancy and its complications in women after SINC are lacking. Aim of the study: Presentation of backgrounds and specificity of sexual disorders, dysfunctions of partner relationships and contraception in women after SINC.Method: Literature review, authors’ clinical experience.Results and conclusions: Persons with sexual dysfunction following SINC should be subjected to psychological evaluation and specified sexual education. These specific interventions should be introduced at the appropriate time and take into account functional progress made during rehabilitation and the level of patients’ acceptance of disability. Partner’s involvement is crucial for effective psychotherapy of persons after SINC. A possibility to take the advantage of experience of other persons with a similar disorder is of particular value during the therapy. There is a positve correlation between the ability to experience sexual satisfaction and quality of social adaptation after SINC. The form, acceptance and efficiency of sexual education in persons after SINC are affected by cultural conditions.nces (SINC) is a difficult object of scientific investigations and is not as accurately described as sexual impairment in men after SINC. In particular, systematic reports on pregnancy and its complications in women after SINC are lacking. Aim of the study: Presentation of backgrounds and specificity of sexual disorders, dysfunctions of partner relationships and contraception in women after SINC.Method: Literature review, authors’ clinical experience.Results and conclusions: Persons with sexual dysfunction following SINC should be subjected to psychological evaluation and specified sexual education. These specific interventions should be introduced at the appropriate time and take into account functional progress made during rehabilitation and the level of patients’ acceptance of disability. Partner’s involvement is crucial for effective psychotherapy of persons after SINC. A possibility to take the advantage of experience of other persons with a similar disorder is of particular value during the therapy. There is a positve correlation between the ability to experience sexual satisfaction and quality of social adaptation after SINC. The form, acceptance and efficiency of sexual education in persons after SINC are affected by cultural conditions.
5
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Contemporary methods of urinary system evaluation in patients after spinal injury complicated by neurological deficits: Diagnostics of the upper urinary tract

51%
Tederko P., Lewandowski J., Krasuski M., Kiwerski J.
Medical Rehabilitation
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2007
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vol. 11(3)
21-28
EN
Introduction: Morbidity and mortality related to urinary tract diseases in patients after spinal injury with neurological disturbances (SIND) are modifiable if prompt and rational diagnostics and therapy are implemented in comprehensive care. SIND increases the risk of urinary tract damage resulting from neurogenic bladder dysfunction, sequels of patient’s immobilisation, nephrotoxic effect of pharmacotherapy, necessity of bladder catheterisation. Severe damage to the urinary system resulting from reflux, urolithiasis, hydronephrosis, recurrent pyelonephritis can occur both during the early and the late phase following SIND. The risk of urinary tract cancer is markedly increased in SIND patients. The natural history of urinary tract diseases in SIND patients might be changed. The course of the disease can be scant in symptoms and signs until late stages. Study design: Overview of scholarly literature.Aim of the study: Presentation and analysis of clinical usefulness of modern tests applied in diagnostics of the urinary tract function in SIND patients. We discussed appropriateness and clinical usefulness of imaging and functional procedures of the upper urinary tract evaluation with special emphasis on basic laboratory tests, modern methods of glomerular filtration rate (GFR) assessment in SIND patients, as well as on the traditional and modern imaging studies.Conclusions: Modern comprehensive care of a patient with SIND, both at the early and late stage following spinal injury, should comprise systematic monitoring of renal function. Efficacious diagnosis is based on meticulous clinical examination. Auxiliary tests are performed according to their availability and the anticipated clinical relevance. First line diagnostic tests should comprise non-invasive techniques. Systematic and credible GFR assessment is indicated in SIND patients. Tests of choice include: 51CrEDTA or 99mTcDTPA clearance, assessment of cystatin-C level, as well as routine imaging studies of the kidneys such as renal radioisotope scanning and ultrasound examination. Urography and computed tomography may serve as auxiliary imaging techniques.
6
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Contemporary diagnostic methods of the urinary system in patients after spinal injury with subsequent neurological deficits: Diagnostics of the lower urinary tract

51%
Tederko P., Krasuski M., Kiwerski J.
Medical Rehabilitation
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2007
|
vol. 11(2)
21-26
EN
Introduction: Spinal injury with neurological deficit usually results in a neurogenic bladder disorder. The problem may range from total lack of micturition during the spinal shock phase to various forms of detrusor-sphincter dyssynergia. Typical consequences include increased intra-vesical pressure, inability to effectively empty the bladder, increased risk of vesico-ureteral reflux, infection, bladder or kidney stones, neoplastic complications within the urinary tract and renal failure. Proper diagnostics of urinary tract function and morphology enables choosing adequate bladder emptying strategy, early diagnosis and effective treatment of urinary complications in patients after spinal injury with neurological deficit.Study purpose: Presentation of contemporary methods of functional, imaging and endoscopic diagnostic tests of the lower urinary tract in patients with spinal injury with neurological deficit. We discuss clinical value and accuracy of particular diagnostic methods in prevention and monitoring of the therapy of urinary complications.Study form: Literature review.Conclusions: Although urodynamic studies serve as the principal tool among the modern methods of the lower urinary tract function assessment, simple functional tests such as measurement of residual urine volume measurement or cystometrogram may be helpful in clinical practice, particularly during the early post-traumatic phase. Ultrasonographic examination is the first choice imaging study. Clinical validity of screening cystoscopy in spinal injury with neurological deficit patients remains doubtful, but this procedure is of unquestionable value in cases with haematuria.
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