Chronic Subdural Hematoma (CSH) is Still an Important Clinical Problem. Analysis of 700 Consecutive Patients

Background

Chronic subdural hematoma (CSH) is still an important neurosurgical problem and the number of patients increases despite the progress in early diagnosis of cerebral lesions.

Methodology

We analyzed a group of 700 consecutive patients treated in neurosurgical departments for CSH. Clinical state on admission was evaluated according to the Markwalder scale, all patients had CT studies and were operated using craniotomy or burr holes with closed system drainage techniques.

Results

More than 50% had extensive intracranial bleeding, almost half of the patients were treated with oral anticoagulants. The patients with extensive fresh bleeding were in significantly worse states on admission and were treated by craniotomy and external capsulectomy (42%). All the others had burr holes and closed system drainage of the subdural space. Results of treatment were acceptable, 2% died, and 1.5% remained vegetative, due to massive hemorrhage and severe neurological deficits on admission.

Conclusions

Despite a progress in diagnosis, CSH still remains an often cause of severe intracranial complications. The rising number of occurrences of this lesion is strictly connected with a wide use of oral anticoagulants. Surgical removal of CSH still remains the best type of treatment for such lesions.

Loneliness in the Context of Quality of Life of Nursing Home Residents

Background

Numbers of the elderly have been on a steady increase both in Poland and other countries of the world. As they age, their health declines and they need help with their housekeeping. This, coupled with the transformation of intergenerational into single-generation or nuclear family structures, causes a markedly rising demand for institutional care. Holistic care of an elderly nursing home resident requires a comprehensive approach and consideration for their feelings. Loneliness and solitude are increasingly common among these feelings, undoubtedly affecting quality of life.

Method

250 elderly residents of seven nursing home situated in Mazovia, Poland, have been examined using: De Jong Gierveld Loneliness Scale, WHOQOL-BREF Questionnaire, Basic Hope Scale (BHI-12), Satisfaction with Life Scale (SWLS), Acceptance of Illness Scale (AIS).

Results

Loneliness affects nearly 40% residents of the homes surveyed. Quality of their residents’ lives is reduced. Relations with their families and levels of motor efficiency imply a sense of loneliness. Degrees of illness acceptance, ability to adjust to change, and life satisfaction influence the level of loneliness felt.

Conclusion

40% of nursing home residents exhibit a sense of loneliness, while the greater loneliness and solitude, the lower the quality of life.

Associations of Diabetic Retinopathy with Retinal Neurodegeneration on the Background of Diabetes Mellitus. Overview of Recent Medical Studies with an Assessment of the Impact on Healthcare systems

Diabetes Mellitus (DM) is one of the biggest healthcare and financial problems worldwide. The disease is strongly associated with microvascular and macrovascular complications, causing co-existing diseases like Diabetic Retinopathy, Diabetic Neuropathy and Diabetic Nephropathy. Annual healthcare expenditures for diabetes treatment and complications prevention cost 727 billion USD in year 2017. Diabetes Mellitus, Diabetic Retinopathy and Diabetic Retinal Neuropathy are closely related diseases - originating from incorrectly controlled glycemia, blood pressure and lipid levels in the course of increasing resistance of the body tissues to insulin. Irrespectively of thorough programs for Diabetes Mellitus prevention and treatment, Diabetic Retinopathy management requires targeted treatment strategies for both microvasculopathy and retinal neurodegeneration, to delay disease severity course and risk of blindness. The study and conclusions in this article are based on web-available data and officially published articles related to the diabetes mellitus and associated diseases - Diabetic Retinopathy and Diabetic Retinal Neuropathy. The articles have been reviewed and analyzed to assess mutual relations between the discussed diseases.

Vertebroplasty (PVP) is effective in the treatment of painful vertebral hemangiomas

We assessed the results of percutaneous vertebroplasty treatment of painful vertebral hemangiomas in 110 patients, with a three years follow-up. 110 patients with painful vertebral hemangiomas were treated by percutaneous vertebroplasty. The patients were diagnosed by MRI and observed for 3 years after surgery. Visual Analog Scale was used to assess the level of pain. Pain significantly diminished in all patients, 90% were free of pain for three years after augmentation. In 10% some pain appeared after 1 year, but less intensive than before surgery. 3 years after vertebroplasty 90% of patients were free of pain. No complications of PVP were observed. In 3 patients extravertebral leakage was noted with no clinical symptoms. PVP is highly effective in the treatment of painful vertebral hemangiomas. The method is safe, produce minimal complications and eliminates, or highly reduces pain for a long time period.

Keyhole Surgery of Pineal Area Tumors - Personal Experience in 22 Patients

Background

Pineal area tumors are challenging for surgery due to their location. However, the removal of the lesion is critical for further treatment and survival of the patients

Material and methods

22 patients with pineal area tumors were surgically treated via keyhole medial suboccipital craniotomy and supracerebellar midline approach All the patients were operated in the sitting position with the use of operating microscope and microsurgical technique.

Results

All patients survived surgery in a perfect condition, and no one patient worsened after surgery. No complications due to the sitting position were noted.

Conclusions

Surgical removal of pineal area tumors via small suboccipital craniotomy is safe and with the use of microsurgical techniques the results of surgical treatment are excellent. The sitting position of the patients gives a better view to the surgeon. We did not observe any intraoperational complications due to the sitting position.

Cigarette Smoking and Respiratory System Diseases in Adolescents

Respiratory system diseases are common in youngsters, smoking being one of the main cause of them. In this article, results are presented of a survey-type study on smoking and respiratory malady conducted in 3108 high school students from the Mazovian Region in Poland. The questionnaire made for this study contained questions concerning the health status, chronic diseases, and the cigarette smoking habit. The subjects were high school student aged 15-19. Overall, 1694 males and 1414 females were enrolled in the study. Regarding males, 66.4 % of them were non-smokers, 18.1 % smoked up to 20 cigarettes daily, and 15.5 % smoked more than 20 cigarettes daily; 12.5 % of all smokers smoked longer than one year. Overall, 38.5 % of males reported symptoms of chronic bronchitis. When stratified by the smoking habit, chronic bronchitis was reported by 21 % of non-smokers and 71 % of all smokers. Regarding females, 77 % of them were non-smokers, 16 % smoked up to 20 cigarettes daily, and 7 % more than 20 cigarettes daily; 8 % of all smokers smoked longer than one year. Overall, 35 % females reported symptoms of chronic bronchitis. When stratified by the smoking habit, chronic bronchitis was reported by 23 % of non-smokers and 75 % of smokers. Bronchial asthma was reported by 22 (0.7 %) subjects, none of them was a smoker. In conclusion, males more often than females smoked cigarettes. The number of persons complaining of symptoms of chronic bronchitis was markedly higher in the group of smokers. The study shows that smoking is a key cause of chronic bronchitis in adolescents. That implies a need for enhanced educational activity on the adverse effects of smoking and undertaking active anti-smoking campaigns at the level of high school.

Retrospective study of injury rates among children and adults in the Lublin Region of Poland

INTRODUCTION AND OBJECTIVE

In Poland and worldwide, injury rates, as well as accident rates among children and adolescents still remain a social, health and economic problem, despite an attempt to inhibit the growing tendency of this phenomenon.

OBJECTIVE

An attempt to evaluate current trends in injury rates among children and adolescents based on the example of two provinces in the Lublin Region of Poland during the period 2006-2010.

MATERIALS AND METHOD

The retrospective study was conducted by the method of examination of documents, using the technique of content analysis. The research material was data from the Emergency Procedures Charts and Medical Emergency Team Response Charts, while the study group were children and adolescents aged from 6 weeks - 19 years, from the counties of Kraśnik and Świdnik in the Lublin Region.

RESULTS

Analysis of the research material showed that during the period examined the number of injuries and accidents in the study group remained on a constant level, with a slight decrease in the number of events at home, accompanied by an increase in the number of road accidents and events which occurred in the school environment and in a public place. It was also found that the spring-autumn season, and in particular the summer months, the age group 7-13 and male gender exerted an effect on the number of injuries and accidents. The analysis did not confirm that injuries related with employment of children and adolescents in agriculture and deaths due to external causes constituted a considerable percentage of the events registered.

CONCLUSION

Analysis of trends should be a basis for the planning of prophylactic actions and the promotion of safety in all environments in which the study population functions.

Complications of percutaneous vertebroplasty: An analysis of 1100 procedures performed in 616 patients

Percutaneous vertebroplasty (PVP) is a minimally invasive procedure widely used for the treatment of pain due to vertebral fractures of different origins-osteoporotic, traumatic, or neoplastic. PVP is minimally invasive, but the complications are not rare; however, they are in most cases not significant clinically. The most frequent is cement leakage, which can occur onto veins, paravertebral soft tissue, into the intervertebral disk, or to the spinal canal, affecting foraminal area or epidural space. We analyzed results of treatment and complications of vertebroplasty performed with the use of polimethylomethylacrylate cement (PMMA) on 1100 vertebrae, with a special regard to the severity of complication and eventual clinical manifestation. One thousand one hundred PVP were analyzed, performed in 616 patients. There were 468 (76%) women and 148 men (24%), 24 to 94-year old, mean age 68 years. From 1100 procedures, 794 treated osteporotic and 137 fractures due to malignant disease, 69 PVP were made in traumatic fractures. One hundred patients had painful vertebral hemangiomas. Seven hundred twenty-six (66%) lesions were in thoracic, and 374 (34%) in lumbar area. Results of treatment were assessed using 10 cm Visual Analogue Scale (VAS) 12 hours after surgery, 7 days, 30 days, and then each 6 months, up to 3 years. Before surgery all patients had significant pain 7 to 10 in VAS scale, mean 8.9 cm. Twelve  hours after surgery 602 (97.7%) reported significant relief of pain, with mean VAS of 2,3 cm. Local complications occurred in 50% of osteoporotic, 34% of neoplastic, 16% of traumatic fractures, and 2% of vertebral hemangiomas. The most common was PMMA leakage into surrounding tissues-20%; paravertebral vein embolism-13%; intradiscal leakage-8%; and PMMA leakage into the spinal canal-0.8%. Results of treatment did not differ between patients with and without any complications. From 104 patients who had chest X-ray or CT study performed after surgery, pulmonary embolism was noted in 2 patients, but without any clinical symptoms. Only 1 patient-with PMMA leakage into the spinal canal required surgical decompression In conclusion, PVP is effective in decreasing the level of pain in compression vertebral fractures. Complications occur in almost half of the patients but in more than 95% of them do not produce any clinical symptoms.

[Life satisfaction and self-esteem among women in the menopausal time]

INTRODUCTION

The period of menopause is usually a long-lasting, running process, with strong hormone changes which are manifested with somatic disorders and the lability of the emotional state. The degree of severity of the occurence of these symptoms can be variously bolstered. These changes can affect the quality of life and ones self-esteem.

THE AIM

To assess the level of self-esteem of biopsychosocial functioning women in the menopausal time and the impact of menopause on women's quality of life.

MATERIAL AND METHODS

A group of 90 women in perimenopausal aged 49-61 were enrolled in the study. Standardized psychological questionnaires (Kupperman Index, SES Rosenberg and WHOQoL-BREF) were used. Additional data was collected by using a questionnaire developed by the authors. In statistical analysis χ2, analysis of variance and Spearman's rank correlation models were used.

RESULTS

A significant correlation relationship between level of education and the sphere of psychological evaluation (p <0.05); and between the place of residence, and the assessment of the quality of life in the social (p <0.1) and environmental (p <0.1) sphere. Among the respondents, 95.45% of women received the result of the scale SES > 25 indicating the correct (in the normal or higher range) self-esteem.

CONCLUSIONS

In the studied group, women believe that they have the correct (in the normal or higher range) self-esteem. The surveyed women found as good their quality of life, the highest rated was social and psychological sphere, the lowest score received sphere of physical functioning (somatic). A statistically significant correlations were achieved between home and professional activity, and the assessment of the quality of life in the social and environmental sphere. The analysis showed a significant association correlation between level of education of women and the sphere of psychological evaluation.

Factors affecting decision concerning influenza vaccination among students of medical faculties

Influenza is one of the most common cyclic respiratory diseases in humans. Methods of prevention are multidirectional, but the most effective and most efficacious way to prevent influenza and its complications is through preventive vaccination. This work aims to determine different factors affecting the decision concerning influenza vaccine. The percentage of people vaccinated against the flu was evaluated, as well as their knowledge of post-influenza complications, etc. among full-time students and bridging studies of nursing and physiotherapy (full-time and part-time) at the University of Technology and Life Sciences in Radom, and students of medicine and pharmacy at the Medical University of Łódź. The research tool was the authors' questionnaire with 18 questions. The surveys conducted, consisting of multiple choice questions, were anonymous. In total, the survey involved 470 students. Overall, the number of people who were vaccinated against influenza in the 2012/13 epidemic season numbered 15 respondents, representing 5.84% of the total group of respondents. For the group of nursing students it was 6%, for physiotherapy students 5%, for students of medicine and pharmacy 14%. The percentage of respondents who said they would get vaccinated if the vaccinaton was free of charge was also low. Increasing the percentage of people vaccinated against influenza (immunization coverage) is a very important measure in preventing influenza epidemics. Therefore, it is necessary to identify the reasons why people are reluctant to be vaccinated against influenza, particularly among students who will work in the future in the health care services sector.

Factors affecting decision concerning influenza vaccination among students of medical faculties

Influenza is one of the most common cyclic respiratory diseases in humans. Methods of prevention are multidirectional, but the most effective and most efficacious way to prevent influenza and its complications is through preventive vaccination. This work aims to determine different factors affecting the decision concerning influenza vaccine. The percentage of people vaccinated against the flu was evaluated, as well as their knowledge of post-influenza complications, etc. among full-time students and bridging studies of nursing and physiotherapy (full-time and part-time) at the University of Technology and Life Sciences in Radom, and students of medicine and pharmacy at the Medical University of Łódź. The research tool was the authors' questionnaire with 18 questions. The surveys conducted, consisting of multiple choice questions, were anonymous. In total, the survey involved 470 students. Overall, the number of people who were vaccinated against influenza in the 2012/13 epidemic season numbered 15 respondents, representing 5.84% of the total group of respondents. For the group of nursing students it was 6%, for physiotherapy students 5%, for students of medicine and pharmacy 14%. The percentage of respondents who said they would get vaccinated if the vaccinaton was free of charge was also low. Increasing the percentage of people vaccinated against influenza (immunization coverage) is a very important measure in preventing influenza epidemics. Therefore, it is necessary to identify the reasons why people are reluctant to be vaccinated against influenza, particularly among students who will work in the future in the health care services sector.

Treatment of multiple osteoporotic vertebral compression fractures by percutaneous cement augmentation

PURPOSE

Vertebral compression fractures cause significant pain and some patients are debilitated by the pain due to the fracture. Conventional surgery carries a high risk and has a poor outcome. Vertebroplasty is a minimally invasive surgical procedure, which in vertebral fractures restores stability and diminishes pain. The aim of the study was to analyse the effectiveness and safety of vertebroplasty in multiple vertebral compression fractures with a 24-month follow-up.

METHODS

Vertebroplasty was performed in 160 patients with multiple osteoporotic compression fractures under local anaesthesia, using a unilateral transpedicular approach. The level of pain was assessed according to a 10-cm visual analogue scale. The patients were observed for 24 months after surgery.

RESULTS

Vertebroplasty significantly diminished the level of pain in 90% of patients, and half of them were free of pain within 12 hours after surgery. Only 4% of the patients did not benefit from this type of treatment. During the 24-month follow-up these results changed only slightly, and after two years almost 80% still benefited, while the number of unsatisfactory results changed from 6 to 9%. No serious clinical complications were noted; in three patients new fractures appeared during the two year observation period.

CONCLUSIONS

Vertebroplasty should be seriously taken into account as a primary method of treatment in patients with multiple osteoporotic vertebral compression fractures.