Quality of life and its selected determinants in the group of patients with surgically treated spinal tumors.

Introduction: Spinal metastases are a common manifestation of advanced neoplastic disease. Destructive neoplastic lesions within the axial skeleton cause unrelieved pain and nervous system disorders involving spinal stenosis and other neural structures. The development of new systemic therapies, radiotherapy and minimally invasive spinal surgeries has increased patients' quality of life by minimising pain and neurological disorders due to vertebral neoplastic infiltration. The aim of the study was to assess the patients' quality of life before and after spine stabilisation surgery with spinal cord decompression to relieve the pressure associated with neoplastic destruction. Materials and Methods: The study involved 115 subjects with spinal metastases in the preoperative period and 3-4 months after the surgery based on the inclusion criteria (metastatic spinal tumour, sensorimotor dysfunction). The data were collected using the following tools: the Rotterdam Symptom Checklist (RSCL-Rotterdam Symptom Checklist), Acceptance Illness Scale (AIS scale), Activities of Daily Living Scale (ADL scale) and Visual Analogue Scale (VAS). The correlation coefficient was calculated using Spearman's rho assuming the significance level at α = 0.05 (p<0.05). Results: A higher quality of life was found after surgery (p<0.001) in terms of experiencing physical symptoms (30.7 ± 11.96 points before surgery vs. 20.91 ± 13.00 points after surgery) and psychological symptoms (43.98 ± 14.82 points before surgery vs. 31.35 ± 14.86 points after surgery). The activity level of the subjects also improved (p<0.001; 36.56 ± 22.43 points to 43.55 ± 20.40 points). The level of disease acceptance in the study group was higher after the surgery compared to the preoperative assessment. The subjects with a high level of disease acceptance presented a higher quality of life postoperatively. The independence of the subjects in performing everyday activities after the operation influenced the quality of life, in terms of somatic symptoms (p=0.006), mental symptoms (p=0.001) and activity (p<0.001). Along with the improvement in functional capacity, the quality of life in terms of symptoms and activity levels increased. Conclusion: The study showed that spinal cord decompression surgery improves the quality of life of patients by reducing neurological dysfunction, increasing the acceptance of the disease and the ability to perform activities of daily living (ADL). Sociodemographic variables did not affect the quality of life of the respondents.

Use of negative pressure wound therapy in a chronic leg wound with coexisting rheumatoid arthritis: a case study.

We present a case of a 69-year-old woman with rheumatoid arthritis. The patient's condition was managed with steroid therapy for more than 12 years. She had a coexisting infected chronic ulceration in the left leg, which was treated with negative pressure wound therapy for 52 days. Use of this therapy within the wound reduced exudate and the bacterial count, which dramatically accelerated the process of wound healing.

Marjolin's ulcer in chronic wounds - review of available literature.

Marjolin's ulcer is a rare, aggressive skin cancer developing in scar tissue, chronic ulcers and areas affected by inflammations. Its incidence is estimated to range from 1% to 2% of all burn scars. It most frequently takes the form of squamous cell carcinoma which sometimes is diagnosed during examination of lesions developing in scars and hard-to-heal chronic wounds (pressure sores, leg ulcers). Therapeutic management of Marjolin's ulcer requires well-designed treatment plan to ensure optimal medical care and good quality of life for the patient. The high risk of metastases and damage to the structure of vitally important organs determines the need for early diagnosis and prompt surgical intervention with supplementary therapy. The purpose of the study was to examine etiopathogenesis of Marjolin's ulcer and principles of its treatment. The authors focused on the aspect of malignant degeneration in chronic wounds (leg ulcers, pressure sores) as a very rare, aggressive form of Marjolin's ulcer. A review of the available literature on the issue of Marjolin ulcers was conducted using the key words; Marjolin ulcers, pressure sore, chronic wound. Malignant degeneration in chronic wounds is a very rare aggressive form of Marjolin ulcer. Increased oncological alertness should be displayed by nursing and medical personnel taking care of patients with chronic wounds.

Metastasis of adenocarcinoma of an unknown primary site to the right crus simulating sarcoma - a case report.

More bony malignancies are metastatic than primary tumours. Usually, it is not difficult to distinguish a metastasis from a primary tumour; however, when the metastasis is the first manifestation of malignant disease, diagnosis may cause numerous difficulties and lead to therapeutic errors. A patient with one year's history of pain in the right crus who was initially suspected of having sciatica and venous thrombosis was referred to an orthopaedic department when radiographs of the crus were suspicious for an osteosarcoma. CT and MRI scans revealed a tumour originating in the proximal fibula with numerous periosteal reactions. A biopsy indicated metastatic adenocarcinoma. Further diagnostic examinations didn't reveal the primary tumour. A PET scan showed a small pulmonary nodule of unknown aetiology. The patient underwent limb-sparing surgery followed by chemotherapy. The diagnostic work-up of bony malignancies may pose difficulties. Despite a characteristic presentation of sarcomas of bone in imaging examinations, it may be impossible to distinguish metastases and primary tumours. This problem especially concerns patients in whom metastases are the first manifestation of malignant disease and imaging examinations show no abnormalities in internal organs. Histopathological evaluation should be mandatory for all bone tumours which are not confirmed metastases before any therapeutic decisions are made. One must be aware of limitations and errors related to diagnostic work-up in oncology, including histopathological examinations. Sometimes it may be impossible to obtain a result of microscopic analysis compatible with the clinical presentation.