Magdalena Mackiewicz-Milewska

Deep venous thrombosis in patients with chronic spinal cord injury

Context/Objective: Deep venous thrombosis (DVT) is a well-known complication of an acute spinal cord injury (SCI). However, the prevalence of DVT in patients with chronic SCI has only been reported in a limited number of studies. The aim of our study was to examine the prevalence of DVT in patients with SCI beyond three months after injury. Design: Cross-sectional study. Setting: Rehabilitation Department at the Bydgoszcz University Hospital in Poland. Participants: Sixty-three patients with SCI that were more than 3 months post injury. The patients, ranging in age from 13 to 65 years, consisted of 15 women and 48 men; the mean age of the patients was 32.1 years. The time from injury varied from 4 to 124 months. Outcome measures: Clinical assessment, D-dimer and venous duplex scan. Results: The venous duplex scan revealed DVT in 5 of the 63 patients. The post-injury time in four of the patients varied between 4 and 5 months; one patient was 42 months post-injury. Conclusion: DVT occurred in patients with chronic SCI, mainly by the 6th post injury month.

Long term results of childhood dysphonia treatment.

OBJECTIVE The aim of this study was to assess the long term results of treatment and rehabilitation of childhood dysphonia. METHODS This study included a group of adolescents (n=29) aged from 15 to 20 who were treated due to pediatric hyperfunctional dysphonia and soft vocal fold nodules during their pre-mutational period (i.e. between 5 and 12 years of age). The pre-mutational therapy was comprised of proper breathing pattern training, voice exercises and psychological counseling. Laryngostroboscopic examination and perceptual analysis of voice were performed in each patient before treatment and one to four years after mutation was complete. The laryngostroboscopic findings, i.e. symmetry, amplitude, mucosal wave and vocal fold closure, were graded with NAPZ scale, and the GRBAS scale was used for the perceptual voice analysis. RESULTS Complete regression of the childhood dysphonia was observed in all male patients (n=14). Voice disorders regressed completely also in 8 out of 15 girls, but symptoms of dysphonia documented on perceptual scale persisted in the remaining seven patients. CONCLUSIONS Complex voice therapy implemented in adolescence should be considered as either the treatment or preventive measure of persistent voice strain, especially in girls.

Assessment of quality of life in women five years after breast cancer surgery, members of Breast Cancer Self-Help Groups – non-randomized, cross-sectional study

Aim of the study To assess the quality of life in patients treated for breast cancer who were 5 years after diagnosis and were active members of Breast Cancer Self-Help Groups. Material and methods The study had a non-randomized, cross-sectional design. We enrolled 167 women who were more than 5 years after mastectomy and were active members of Breast Cancer Self-Help Groups (group A1). As a control group we enrolled 117 women after mastectomy – not members of such support groups (group A2). For the evaluation of the quality of life in both groups we used the following standardized questionnaires – EORTC QLQ-C30 and EORTC QLQ-BR23 as well the Mini-MAC scale for the assessment of strategies of coping with disease. Results Based on QLQ C30 scores, group A1 had better emotional functioning (p = 0.0005) and a higher general quality of life (p = 0.0259), whereas group A2 had better role functioning (p = 0.0042). Based on QLQ BR23 scores, there were statistically significant differences in body image (p = 0.0366) and life perspectives (p = 0.0313) in favor of group A1. In the control group, there was a greater use of destructive coping strategies and anxious preoccupation (p = 0.1957). Conclusions Membership in Amazon groups improves functioning in breast cancer patients that can also extend into a five-year period after treatment completion.

Transpedicular Stabilization Complications in Thoracic Region of the Spine After SCI - Three Cases Report and Literature Review

Opisano trzy przypadki pacjentow, u ktorych wystąpily powiklania po stabilizacji transpedikularnej odcinka piersiowego kregoslupa. Celem pracy bylo opisanie powiklan po stabilizacji odcinka piersiowego kregoslupa, ktore mogą byc niebezpieczne dla zdrowia i zycia chorych oraz są przyczyną wystąpienia wielu dolegliwości. 1 opis przypadku. 24-letnia chora po zlamaniu kregoslupa z uszkodzeniem rdzenia kregowego na poziomie T9 i T12. Zostala zakwalifikowana do wykonania stabilizacji transpedikularnej na wysokości od T8 do T10 oraz od T11 do T12. W klasyfikacji ASIA A, bez czucia oddawania moczu i stolca oraz czynności zwieraczy odbytu i cewki moczowej. Powiklaniem po stabilizacji bylo nieprawidlowe umieszczenie śruby transpedikularnej oraz zakazenie rany pooperacyjnej. Wskutek tych powiklan konieczne bylo usuniecie calej stabilizacji transpedikularnej. Zdarzenia te znacznie spowolnily i ograniczyly caly proces rehabilitacji. Pacjentka lącznie zostala poddana trzem operacjom neurochirurgicznym wskutek nieprawidlowego umieszczenia śrub transpedikularnych. 2 opis przypadku. 31-letni mezczyzna po urazie rdzenia kregowego na wysokości T6. Wykonano stabilizacje transpedikularną na poziomach od T5-T6. Powiklaniem bylo nieprawidlowe umieszczenie w trzonie kregu T5 śruby transpedikularnej, co spowodowalo powstanie tetniaka aorty. Ostatecznie chory ponownie byl operowany przez zespol neurochirurgow i chirurgow naczyniowych z dobrym rezultatem. 3 opis przypadku. 26-letni mezczyzna po zlamaniu kregoslupa i uszkodzeniu rdzenia kregowego na wysokości T5 i T6. Po wykonaniu stabilizacji transpedikularnej wzrosly parametry stanu zapalnego tj. gorączka oraz cechy zapalenia drog oddechowych. Wykonano zdjecie radiologiczne pluc, ktore wykazalo zapalenie oplucnej oraz nieprawidlowe polozenie śrub transpedikularnych w trzonach T3 i T4. Chorego leczono zachowawczo. Wnioski. Powiklania opoźniają oraz zaburzają caly proces rehabilitacji pacjenta. Kontrola radiologiczna po wykonaniu stabilizacji transpedikularnej powinna byc wykonywana rowniez po zabiegu operacyjnym, aby zapewnic choremu bezpieczną pionizacje oraz nauke chodu. Wystąpienie dolegliwości bolowych wzdluz dermatomow odpowiadających poziomom wykonanej stabilizacji transpedikularnej moze wskazywac na nieprawidlowe polozenie śrub transpedikularnych. W odcinku piersiowym takie powiklanie moze byc groźne dla zycia chorych, z powodu bliskiego polozenia waznych struktur anatomicznych.

Tracheocoele – powikłanie po dekaniulacji ☆ ☆☆ ◊ ◊◊

Summary A case of tracheocoele as a complication after decanniulation in a patient after brain trauma is presented. Within twelve months after decanniulation patient was operated three times to close the tracheocutaneous fistula without good effect. A pretracheal air cyst was recognized after the radiological examinations. Tracheocoele was evacuated with its tract. No recurrences were observed.A case of tracheocoele as a complication after decanniulation in a patient after brain trauma is presented. Within twelve months after decanniulation patient was operated three times to close the tracheocutaneous fistula without good effect. A pretracheal air cyst was recognized after the radiological examinations. Tracheocoele was evacuated with its tract. No recurrences were observed.