Biomedical subjects

A Zyluk

Publications and source records attributed to A Zyluk.

At least 19 recordsLinked to original sources

PubMed2006

A comparison of two limited open techniques for carpal tunnel release.

Review of the literature shows the effectiveness of limited open carpal tunnel release to be comparable to that of endoscopic carpal tunnel release in respect of recovery of grip strength, time of return to work and complication rate. A randomised, controlled study was designed to compare the effectiveness of a single versus a double limited open technique of carpal tunnel release. Sixty-five patients (73 hands) with a mean age of 48 years were operated on, 40 hands by the single incision and 33 by the double incision method. Grip and pinch strengths, digital sensibility (Filament and 2PD tests) and Levine scores were evaluated throughout 12 months of follow-up. We found that the single incision method offers better results in respect of grip and pinch strengths: less weakness at 1 month after surgery and a faster improvement relative to pre-operative values which is statistically significant. This, however, did not translate directly into Levine functional and symptom scores which, at each assessment, did not differ significantly between the two methods.

Adult↗

PubMed2005

Complex regional pain syndrome type 1 after fractures of the distal radius: a prospective study of the role of psychological factors.

A prospective study was designed to investigate the question "Do patients who develop Complex Regional Pain Syndrome Type 1 (CRPS Type 1) after fracture of the distal radius display different psychological behaviour patterns and/or are more depressive than those who recover uneventfully after this fracture?" Sixty-two patients of mean age 56 years with displaced distal radius fractures were operated on by closed reduction and percutaneous fixation with K-wires. All these patients were examined psychologically on the day after the operation. A series of standardized, self-administered questionnaires was used to assess personality and depression. Fifty of the 62 patients were reassessed at 2 months for symptoms and signs of CRPS Type 1 and a diagnosis of this condition made on clinical grounds. Nine patients (18%) were diagnosed as having CRPS Type 1. There were no significant differences in scores on any of the personality and depression scales between CRPS Type 1 and non-CRPS Type 1 patients. Therefore, patients who eventually developed CRPS Type 1 after radial forearm fracture had neither a unique psychological pattern nor displayed more symptoms of depression than those who recovered uneventfully.

Female↗

PubMed2003

A new clinical severity scoring system for reflex sympathetic dystrophy of the upper limb.

A scoring system for the clinical severity of reflex sympathetic dystrophy (RSD) is proposed. The following signs and symptoms were considered to be significant: pain, reduction of finger flexion, swelling, temperature changes, discolouration, sensory disturbances, shoulder pain and loss of movement, increased sweating, and hair/nail growth changes. One point was assigned for strong expression of most of these features, half a point for moderate expression and no point if the feature was absent. A total score of 4 points was assumed, empirically, to indicate a mild degree of RSD, and the maximum score of 10 to indicate the most severe form of RSD. One hundred and forty-six patients with RSD of the hand were classified according to this system. Seventy-four patients (51%) had a score of 4-6, 51 patients (35%) a score of 6.5-8, and 21 patients (14%) a score of 8.5-10. Use of this system will allow more precise analysis of RSD patients and facilitate comparisons between studies.

Body Temperature↗

PubMed2002

The usefulness of the Phalen test and the Hoffmann-Tinel sign in the diagnosis of carpal tunnel syndrome.

Both the Phalen test and the percussion (Hoffmann-Tinel) test are considered to be the classic diagnostic tests for Carpal Tunnel Syndrome (CTS). Sensitivity of these tests, as given in the literature, ranges from 42 to 85% (Phalen) and from 38 to 100% (Hoffmann-Tinel), and specificity from 54 to 98% and from 55 to 100% respectively. The objective of this study was to evaluate sensitivity and specificity of both tests and to analyse the influence of such selected factors, such as patient's age and duration of symptoms. The clinical group consisted of 112 patients (147 hands) with CTS confirmed clinically and on nerve conduction studies. The control group of 50 patients (100 hands) was selected from hospital volunteers, who did not complain of any hand symptoms. Sensitivity and specificity of the Phalen test turned out to be respectively 85 and 89% and for the percussion test, 67 and 68%. There was no significant influence of patients' age upon the test results. Seventeen patients showed negative results for both tests, but in these individuals, the duration of symptoms was significantly longer than in the remaining group. These findings indicated essential diagnostic value for the Phalen test, but considerably smaller for the percussion test. In the diagnosis of long lasting syndromes, the usefulness of both tests is limited.

Adult↗

PubMed2001

The sequelae of reflex sympathetic dystrophy.

This paper presents the results of a retrospective analysis of 94 patients who were assessed at a mean of 11 months after successful treatment of reflex sympathetic dystrophy (RSD) of the hand. Fifty-four percent still complained of pain related to the weather, and many complained of cold intolerance (44%), slight pain after use (34%), nail and hair growth changes (34%), sensory disturbances (34%) and stiffness of fingers in the morning (28%). There were also complaints of reduced finger extension, pain and loss of movement in the shoulder joint and hand swelling after use, and 78% of patients had significantly reduced grip strength. These results suggest that, in spite of resolution of the acute RSD problem, significant long term sequelae of RSD continue to impair function of the hand in a proportion of patients.

Adult↗

PubMed2001

The results of operative treatment of fractures of the thumb metacarpal base.

The results of operative treatment of 21 patients with intraarticular fractures of the thumb metacarpal bone are presented. In 14 patients closed reduction was performed followed by percutaneous fixation with one or two K-wires through the metacarpal shaft to the trapezium. In five delayed cases, in which closed reduction was unsuccessful, open reduction and K-wire pinning was performed. After operation the hand and wrist were immobilized for four weeks. In two patients with Rolando-type fractures, an external fixator was used after closed reduction. Patients were followed-up for six months to three years (mean 1.5 years). Consolidation of fractures was achieved in all cases. Fourteen patients had no pain in the hand at final assessment, two complained of mild pain after activity, and another five complained of pain related to the weather. Grip strength of the affected hand ranged from 72% to 85% (mean 80%) of the expected standard value, matched for gender, age and dominant side. Full opposition of the thumb was achieved in all patients. Self-evaluation of the function of the hand expressed on an analogue scale, from 1 (normal hand function) to 5 (total disability), was from 1.1 to 1.5 (mean 1.2). Abduction of the affected thumb measured on x-ray ranged from 30 degrees to 50 degrees and it was 5 degrees-12 degrees less than in the unaffected hand. Secondary degenerative changes seen as narrowing of the trapeziometacarpal joint were observed in 16 patients. All patients returned to their previous occupations, among them five to hard manual work. None reported problems in daily activities. Our results suggest that closed reduction followed by percutaneous K-wire pinning is a valuable method of treatment for acute fractures. When treatment has been delayed an open operative approach should be considered.

Adult↗

PubMed2001

[Sympathetically maintained pain syndrome--a case report].

Sympathetically maintained pain syndrome (SMPS) is considered to be a clinical form of reflex sympathic dystrophy. It develops usually after trauma, and consists of continuous, burning pain with sympathetic component. We present a case of this syndrome affecting both hands, that developed in a patient 3 months after severe burn injury. Intravenous fentolamine test was used to recognise sympathetic transmission of the pain. The management included regional intravenous fentolamine blocks and orally administrated phenoxybenzamine. The former gave only temporary relief; after latter improvement lasted 2 months, but patient eventually failed to recover. Diagnostic and therapeutic considerations concerning this syndrome were underlined.

Burns↗

PubMed2001

[Surgery of the hand in Poland--a controversial issue].

Since hand surgery separated from orthopedic and general surgery as an independent subspeciality, the problem of training new surgery came into life. Many studies indicate that a country with Poland's population should have about 250-300 trained hand surgeons. Current estimates show that there are three to four times less hand surgeons than necessary. The establishment of the Section of Hand Surgery by the Polish Orthopedic Society in 1965 and the founding of the Polish Society for Surgery of the Hand (1998) made formal ground for taking up both training in hand surgery and assenting it as a separate clinical sub-category. No official statement has been made in this matter neither by the Ministry of Health or by any scientific society. The authors suggest the need for organizing a system for training and achieving certified qualifications in hand surgery, for example like the FESSH European diploma in hand surgery. It seems that this matter should be discussed broadly among both general and orthopedic surgeons in order to create a separate sub-category for hand surgery.

Clinical Competence↗

PubMed2000

[Results of treatment for high-pressure injection hand injuries].

High-pressure injection injuries of the hand have a reputation for being dangerous for individual fingers and even for whole hand. Usually appearing innocuous at presentation because of small puncture entry wound, these injuries result in severe damage of most internal structures in finger and hand due to extensive penetration of injected substance. This paper reviews the outcome of the treatment of such injuries in 10 patients: 9 sustained injection of toxic paint, and one lead shot. All the patients were operated on: eight a few hours after injury and two with 3 days delay. The surgical technique included wide exposure from site of injection up to the farthest place in which foreign substance was seen. Thorough debridment of injected material and contaminated tissue was performed with careful preservation of neurovascular structures and tendons. Wounds were not closed, but managed by open technique. In all patients wounds healed well: in 3 by secondary intention, in 6 by delayed closure and 2 were covered by skin grafts. No amputation was performed. Final results were assessed form 1.5 to 3.5 years after initial injury (mean at 2.5 years). Two patients complained of moderate pain related to the weather, five of cold intolerance and two of impaired sensation on fingertips. Active range of motion of affected fingers was in whole group from 90% to 104% (mean 97%) of the range of motion of unaffected fingers from the other side. Range of motion of the wrist (2 patients) was 76% and 117% of range of motion of the other side. Pinch grip strength was from 81% to 116% (mean 99%), and global grip strength from 77% to 119% (mean 97%) of the other side. All patients went back to their previous jobs and periods of sick leave were from 2 weeks to 6 months (mean 3 mo). Excellent results achieved in this study--full functional recovery in 9 of 10 patients confirm the effectiveness of aggressive treatment by open wound technique of such injuries.

Adult↗

PubMed1999

The usefulness of quantitative evaluation of three-phase scintigraphy in the diagnosis of post-traumatic reflex sympathetic dystrophy.

Quantitative analysis of three-phase bone scintigrams was done in 70 patients with reflex sympathetic dystrophy (RSD) and in 30 patients who did not have RSD after injury to the hand or wrist. Regions of interest were selected and the uptake ratios (affected/unaffected) were calculated. Significant differences between affected and unaffected patients were seen in the metacarpal area in phase 2 of the scintigrams as well as in the metacarpophalangeal joints and metacarpal bones in phase 3. Combination of these images had the greatest diagnostic value. Sensitivity and specificity of 80% were achieved in the regions of interest in phase 3. The duration of RSD and the predisposing injury significantly affected the results of bone scintigraphy. It was also noted that a fracture may cause increased fixation of the tracer in each phase of three-phase bone scintigraphy in asymptomatic patients.

Adult↗

PubMed1999

Quantitative evaluation of three-phase bone scintigraphy before and after the treatment of post-traumatic reflex sympathetic dystrophy.

Three-phase bone scans performed in 65 patients with post-traumatic reflex sympathetic dystrophy (RSD) were reviewed to evaluate which changes in uptake of the tracer appear before and after treatment, whether the form of treatment affects the intensity of uptake, and to investigate the correlation between the results of treatment and the intensity of the uptake both at initial and final scintigraphic examination. Forty-nine patients were treated using three different methods; 16 patients were observed without treatment. Bone scintigraphy was performed twice in each patient: first before treatment or observation and then at the final assessment, from 6 to 18 months after the end of treatment. Clinical results were rated as follows: good, moderate and poor. Scintigrams were evaluated quantitatively after processing the data obtained from the selected regions of interest. A significant reduction in the initially increased uptake of the tracer was noted in each phase/region of interest 6-18 months after initial imaging. At final assessment, mean uptake ratios in treated and non-treated patients were similar. This suggests that treatment does not affect the rate of reduction of uptake. In patients with good and moderate response to treatment, mean uptake ratios at initial scanning were significantly higher than in patients with poor outcome. This indicates that three-phase bone scintigraphy has prognostic value in RSD: marked hyperfixation of the tracer indicates better final outcome. At final imaging, the mean uptake ratios of patients with good, moderate and poor response to treatment did not differ significantly. This suggests that three-phase bone scintigraphy has no value in monitoring the course of treatment of RSD.

Adult↗

PubMed1999

[The results of the treatment of post-traumatic reflex sympathetic dystrophy within upper extremity].

Results of a retrospective study of the treatment of 146 patients with post-traumatic reflex sympathetic dystrophy within upper extremity in various stages were presented. Treatment included the following methods: regional intravenous steroid blocks, mannitol, mannitol combined with dexamethasone, physical therapy, calcitonin and surgery. Uniform, clearly defined criteria of diagnosis of the condition and criteria of assessment of the results were used in the study. Final assessment was carried out 6-15 months after ending of the treatment (mean 11 months). Good result (no pain and full finger flexion) was obtained in 94 patients (64%), moderate (pain only after load or loss of flexion less than 3 cm) in 31 (21%) and poor (pain at rest or reduction of flexion more than 3 cm) in 21 (15%). There was found that method of treatment had not significant effect on the result, except surgical treatment after which the worst results were obtained. Significant effect of duration of the disease on the results of the treatment was noted: the earlier treatment the better results. In spite of satisfactory withdrawal of other signs and symptoms, considerable reduction of grip strength after treatment persisted (mean grip strength ratio 28% of the other side) suggesting functional impairment of the hand. The critical approach to evaluation of the results of the treatment of early reflex sympathetic dystrophy was suggested with regard to spontaneous recovery of the condition in many cases.

Adult↗

PubMed1999

[Methods of rehabilitation of fingers after the repair of flexor tendon injuries of first and second degree].

Post-operative rehabilitation of fingers after flexor tendon repair is the important part of therapy which considerably affects final result of the treatment. Method of dynamic traction splinting introduced by Kleinert in 1973, resulted in significantly improvement of final outcomes of repaired flexor tendons, particularly in zone II. Several other than Kleinert dynamic splinting rehabilitation programs were described in the paper. These methods are precisely designed protocols including mode and duration of immobilization of the fingers in the cast, daily range and frequency of finger moves and rate of restoration of the full range of motion. The following rehabilitation protocols were described: active flexion-active extension (Billericay and Belfast), active flexion-active extension using an internal profundus splinting, passive flexion-passive extension and combined regimen of controlled motion with dynamic traction splinting. The late results of the treatment using mentioned above rehabilitation protocols were compared, with respect to proportion of excellent and good results and rate of ruptures of repaired tendons in the course of rehabilitation. Combined regimen of controlled motion with dynamic traction splinting appeared to be superior than other presented methods. There was mentioned that Kleinert dynamic traction splinting, which is the most frequently used post-operative protocol after flexor tendon repairs in Poland, is not the only way of rehabilitation and that other presented methods give comparable results and may be used as an effective, alternative technique.

Clinical Protocols↗

PubMed1999

[Are mental disorders the cause of reflex sympathetic dystrophy: a review].

Predisposition to reflex sympathetic dystrophy (RSD) is defined as personal susceptibility to produce and maintain an excessive reaction in response to nociceptive stimulation. There is suggested that certain psychological traits predispose one to develop RSD, however, some authors claim that emotional and behavioural disturbances are the result rather than the cause of this painful condition. The review of the literature concerning the relations between psychological factors and RSD is presented in the paper. The review revealed no valid evidence to support the opinion that there is particular psychological or personality pattern predisposing one to develop RSD. Nevertheless, the internal susceptibility to RSD has not been completely precluded. On the other hand, there is enough evidence in the literature to substantiate the view that psychological and emotional disturbances are secondary to persistent disease. These changes, however, are not characteristics for RSD but occur also in other patients suffering from severe pain of other origin. There is emphasized in the paper that psychological support has significantly positive effect in the treatment of RSD.

Humans↗

PubMed1998

The natural history of post-traumatic reflex sympathetic dystrophy.

The paper presents the results of a prospective trial to examine the natural history of early reflex sympathetic dystrophy (RSD). Thirty patients with post-traumatic RSD of the hand were observed without treatment. They were reassessed 1, 2 and 6 months after diagnosis with a final assessment at 10 to 18 months (average 13 months). Twenty-seven patients completed the study. Three were withdrawn during the study because of persistence of signs and symptoms of RSD and were given further treatment. Of the 27 patients who completed the study, only one showed sufficient features of the condition to warrant the diagnosis of mild RSD. In the remaining 26, most features of RSD had resolved spontaneously. Pain and swelling disappeared more quickly than other features of RSD. Although the signs and symptoms of RSD had largely gone at 13 months, the hands were still functionally impaired because of weaker grip strength.

Disease Progression↗

PubMed1998

5T4 oncofetal antigen in gastric carcinoma and its clinical significance.

OBJECTIVE: To evaluate the role of 5T4 antigen in gastric cancer progression and prognosis. DESIGN: A prospective study of 5T4 antigen expression in primary, secondary and recurrent gastric carcinoma, the relationship to selected prognostic parameters and the course of disease. PATIENTS: Eighty six patients operated on for gastric cancer. TISSUE: One hundred and twenty two gastric tumours were studied, including 86 primary carcinomas, 32 coexisting lymph node metastases and four recurrent carcinomas. METHODS: Immunohistochemistry using 5T4 monoclonal antibody on frozen sections. RESULTS: The 5T4 antigen was detected in 41% of primary gastric tumours including early gastric cancer. A strong relationship was found between 5T4 positivity and tumour histology. Thus, 52% of gastric carcinomas of intestinal type expressed 5T4 antigen compared with 28% of the diffuse type (P = 0.028). Among 16 sets of primary gastric carcinomas and regional lymph node metastases, coordinate 5T4 expression was seen in 14 cases; the other two showed acquisition of positivity on metastatic tumour cells (carcinomas of diffuse type). 5T4 antigen was detected more frequently in carcinomas with p53 accumulation compared with those with undetectable p53 levels (P = 0.015). The presence of 5T4 in cancer cells was correlated with poor short-term prognosis (24% vs 49% of 2 year survival for 5T4 positive and negative tumours respectively, P = 0.024). The effect on survival was evident in the p53 negative group, with patients 5T4 positive showing worse survival (28% vs 60% in 2 years). CONCLUSIONS: Our results suggest that the assessment of 5T4 expression in gastric carcinoma can be helpful in identifying patients with poor short-term prognosis.

Adult↗

PubMed1998

[The three-staged evolution of the post-traumatic algodystrophy].

Algodystrophy is considered to develop in three consecutive stages: acute, dystrophic and atrophic. However, there is little evidence documenting this staging in large series of patients. In order to verify the natural history of this condition 30 patients with post-traumatic algodystrophy were observed during one year in prospective controlled fashion. Twenty-three females and 7 males of mean age 60 years were included in the study. All patients, except one, were in stage I of the disease with mean duration of 2,7 months. Fracture of the distal radius was the most frequent predisposing factor. The patients were reassessed at 6 and 13 month after initial diagnosis. A group of 64 patients with algodystrophy subjected to the treatment was also reviewed in search for three-stage evolution of the condition. Of 30 non-treated patients 27 completed the study. Three patients were subjected to the treatment due to persistence or worsening of symptoms. In 26 patients (87%) most of symptoms withdrew at 13 months. In 1 patient some features at final assessment were suggestive of stage II of the disease. Of the 64 treated patients, 2 had developed stage II and in 4 condition persisted at the same stage 12 months. The study suggests that progressive, three-staged course of algodystrophy occurs less frequently than it was earlier suspected. In most cases the condition resolves spontaneously.

Adult↗

PubMed1998

[Transplantation of the greater omentum and complication].

A series of 13 patients (12 males, 1 female, aged 5-57) operated between 1990 and 1997 is presented. In 12 cases the greater omentum was used to cover tissue defect within upper extremity, in 1 case--lower extremity. Complications at donor site and within extremity were assessed in two groups (group I--5 cases of free omentum graft, group II--8 cases of pedicled omentum graft). Two acceptor site complications (flap necrosis and osteomyelitis) and no donor site complications were observed in group I. In group II 2 similar donor site complications occurred but 5 patients from this group complained of strong abdominal pain due to excessively short pedicle of the graft and 1 case of abdominal hernia occurred. The complications have been analyzed, means for prevention discussed.

Adolescent↗