Male gender and age range 20-29 years are the most important non-modifiable risk factors for recurrence after primary post-traumatic shoulder dislocation.

PURPOSE: The aim of the study was to identify and analyze non-modifiable risk factors for recurrence after a first-time post-traumatic dislocation of the shoulder in the entire Polish population. METHODS: The entire Polish population was included in a cohort study. Patients diagnosed with primary post-traumatic dislocation of the shoulder between January 1st, 2010 and December 31st, 2011 were identified and followed up from January 1st, 2010 to December 31st, 2014. Incidence and recurrence rates and odds ratios (OR) were calculated. Demographic data were obtained from Poland's Central Statistical Office. Data on the number of patients with primary post-traumatic shoulder dislocation were drawn from the National Health Fund database. RESULTS: A total of 21,739 patients (14,466 males and 7273 females) with a primary shoulder dislocation in Poland were identified in 2010 and 2011. There were 3341 (15.4%) recurrences. Increased risk of recurrence was associated with male gender (OR = 1.92, 95% CI 1.76-2.09, p < 10-10) in the age range of 20-29 years (OR = 2.59, 95% CI 2.38-2.83, p < 10-10). The highest risk of first-time shoulder dislocation was revealed among females in the age group ≥ 80 years (OR = 24.1, 95% CI 22.6-25.7, p < 10-10). The risk of recurrence in the same group was significantly decreased (OR = 0.41, 95% CI 0.32-0.51, p < 10-10). CONCLUSION: Male gender and age range 20-29 years are highest population risk factors for recurrence after primary shoulder dislocation. Female gender and age ≥ 80 years are highest risk factors for the first-time post-traumatic dislocation of the shoulder joint and protective factors for recurrences after the first-time shoulder dislocation. LEVEL OF EVIDENCE: III.

Five-year prevalence of recurrent shoulder dislocation in the entire Polish population.

PURPOSE: The aim of this study was to evaluate five-year prevalence of recurrent shoulder dislocation in the entire Polish population. METHODS: The study involved the entire Polish population between 01 January 2010 and 31 December 2014. Demographic data were retrieved from the Central Statistical Office of Poland. Data on the number of shoulder joint dislocations were retrieved from the database of the National Health Fund. RESULTS: We identified 32,253 Polish residents with shoulder instability. About 0.1% of Polish residents suffered from recurrent shoulder dislocation. Males suffered almost two times more often than females (66% and 34%, respectively), and male gender was recognized as a risk factor of instability (OR = 2.07, p <10-10). Females in their eighth decade of life had the highest risk of recurrent shoulder dislocation (OR = 3.33, p <10-10). In males the highest risk of recurrences was noted for the third decade of life (OR = 1.78, p <10-10). CONCLUSION: The period prevalence rate of recurrent shoulder dislocation in Poland is 83.7 per 100,000 persons per five years. The rate of recurrent shoulder dislocation for the general Polish population is 0.1%. Males suffered from recurrent shoulder dislocation almost twice as frequently as females (OR = 2.07).

Incidence of Posttraumatic Shoulder Dislocation in Poland.

BACKGROUND The incidence of shoulder joint dislocation has been estimated at 11-26 per 100 000 population per year. In our opinion, basic epidemiological data need to be continually updated in studies of large populations. To study the incidence of posttraumatic dislocation of the shoulder joint in the Polish population. MATERIAL AND METHODS We retrospectively investigated the entire Polish population between 1 January 2010 and 1 January 2015. To identify the study group, data collected in the electronic database of the National Health Fund were used. The study group was divided into subgroups to detect possible differences in the incidence of shoulder dislocation with regard to age, sex, and season of the year (month) when the dislocation occurred. RESULTS The cumulative size of the study sample was 192.72 million over the 5 years of the study. We identified 51 409 patients with first posttraumatic shoulder dislocation, at a mean age of 50.83 years (SD 21.12), from 0 to 104 years. The incidence of traumatic shoulder dislocations for the entire study group ranged from 24.75/100 000/year (number of posttraumatic shoulder dislocations per 100 000 persons per year) to 29.09/100 000/year, for a mean of 26.69/100 000/year. CONCLUSIONS In this study, the overall incidence of first-time posttraumatic shoulder dislocations in the Polish general population was 26.69 per 100 000 persons per year. These results are higher than estimates presented by other authors. It is necessary to study, regularly update, and monitor this problem in the general population.

Results of Arthroscopic Bankart Lesion Repair in Patients with Post-Traumatic Anterior Instability of the Shoulder and a Non-Engaging Hill-Sachs Lesion with a Suture Anchor after a Minimum of 6-Year Follow-Up.

BACKGROUND: Shoulder instability is an important clinical problem. Arthroscopic surgery is an established treatment modality in shoulder instability, but it continues to be associated with a high rate of recurrences and complications. The purpose of the study was to analyze late outcomes of arthroscopic repair of Bankart lesions in patients with post-traumatic anterior shoulder instability and non-engaging Hill-Sachs lesion, with special focus on the incidence and causes of recurrences and complications. MATERIAL AND METHODS: We investigated 92 patients (92 shoulders) who underwent surgery on account of post-traumatic anterior shoulder instability. The duration of follow-up ranged from 6 to 12.5 years (mean: 8.2 years). All patients were operated on in the lateral decubitus position using FASTak 2.8-mm suture anchors (FASTak, Arthrex, Naples, Florida). Treatment outcomes were evaluated using the Rowe and University of California at Los Angeles rating system (UCLA). RESULTS: According to Rowe scores, there were 71 (81.5%) excellent, 12 (12.6%) good, 5 (5.3%) satisfactory, and 2 (2.1%) poor results. Rowe scores improved in a statistically significant manner (p=0.00) post-surgery, to a mean of 90 (range: 25-100). Treatment outcomes measured as UCLA scores improved in a statistically significant manner (p=0.00), reaching post-operative levels of 12-35 (mean: 33.5). There were 9 recurrences, 1 case of axillary nerve praxia, and 1 case of anchor loosening. CONCLUSIONS: With rigorous criteria for qualifying patients for surgery, arthroscopic treatment of post-traumatic anterior shoulder instability produces good outcomes and low recurrence and complication rates irrespective of the number of previous dislocations, age, or sex.

Comparison of short- to medium-term results of Coonrad-Morrey elbow replacement in patients with rheumatoid arthritis versus patients after elbow injuries.

BACKGROUND: The aim of this study was to assess the utility of the Coonrad-Morrey elbow prosthesis in patients with severe elbow dysfunction secondary to rheumatoid arthritis (RA) or post-traumatic elbow dysfunction. MATERIAL/METHODS: The study involved 35 patients followed up for a mean of 36 months. The patients were divided into those with RA (Group I) and those with post-traumatic elbow dysfunction (Group II). Treatment outcomes were evaluated according to the Mayo Elbow Performance Score (MEPS) and the Disabilities of the Arm, Shoulder and Hand Score (Quick DASH). RESULTS: According to the MEPS, there were 20 (57.15%) excellent, 12 (34.3%) good, 1 (2.85%) fair, and 2 (5.7%) poor outcomes. The mean post-operative Quick-DASH score for the entire study group was 37.73 points. In subgroup analysis, the MEPS-based evaluation revealed: 14 (70%) excellent, 5 (25%) good, and 1 (5%) satisfactory outcome in Group I, versus 6 (40%) excellent, 7 (46.7%) good, and 2 (13.3%) poor outcomes in Group II. The mean Quick Dash scores were 78.64 points in Group I and 76.36 points in Group II. The final MEPS scores in Group I (p=0.000018) and Group II (p=0.00065) were most markedly influenced by reduction in elbow pain and improvement in the ability to perform activities of daily living (ADL): p=0.000018 in Group I and p=0.000713 in Group II. CONCLUSIONS: The treatment outcomes confirm the utility of arthroplasty for severe elbow dysfunctions; they were most strongly influenced by pain reduction and improved ability to perform activities of daily living.

Phosphocreatine recovery overshoot after high intensity exercise in human skeletal muscle is associated with extensive muscle acidification and a significant decrease in phosphorylation potential.

The phosphocreatine (PCr) recovery overshoot in skeletal muscle is a transient increase of PCr concentration above the resting level after termination of exercise. In the present study [PCr], [ATP], [P(i)] and pH were measured in calf muscle during rest, during plantar flexion exercise until exhaustion and recovery, using the (31)P NMR spectroscopy. A significantly greater acidification of muscle cells and significantly lower phosphorylation potential (DeltaG (ATP)) at the end of exercise was encountered in the group of subjects that evidenced the [PCr] overshoot as well as [ADP] and [P(i)] undershoots than in the group that did not. We postulate that the role of the PCr overshoot-related transiently elevated [ATP]/[ADP(free)] ratio is to activate different processes (including protein synthesis) that participate in repairing numerous damages of the muscle cells caused by intensive exercise-induced stressing factors, such as extensive muscle acidification, a significant decrease in DeltaG (ATP), an elevated level of reactive oxygen species or mechanical disturbances.

[Early results of surgical treatment of haemorrhoids at use of harmonic scalpel]. / Wczesne wyniki operacji zylaków odbytu przy uzyciu noza harmonicznego.

AIM OF THE STUDY: To estimate the usefulness of harmonic scalpel during operation of haemorrhoids. MATERIAL AND METHODS: It presented material 37 patients, 23 women and 14 men, in average from 28 for 76 year, middling 53 year. Operated by harmonic scalpel in haemorrhoids dissease. During the study was evaluate pain scale (NRS), hospitalization time, consumption of analgesics, postoperation complications, time needed to resume regular professional activity. RESULTS: At the 1st, 2st, 1th postoperative mean intensity of pain was respectively: 2.3, 1.2, 1.0 Mean consumption of metamizole during the 1st postoperative day was 2.7 g/24, but to II day 1.1 g/24. Mean consumption of pethidine on the 1st postoperative day was 70.9 mg/24, but to II day 37.8 mg. Time of procedure evaluated from 10 for 44 minutes (median 26,9 minutes). Seven patients was bleeding from operation field. Postoperation complications has been appeared in 10 patient, including: bleeding (6 patients), leak from anal canal at 3 patients and anoderm mucosal oedema at one patient. CONCLUSIONS: Using of harmonic scalpel in hemoroidectomy procedure is technically simple and safe procedure.

[Subacromial impingement syndrome--most frequent reason of the painful shoulder syndrome]. / Zespól ciasnoty przestrzeni podbarkowej--najczestsza przyczyna zespolu bolesnego barku.

Painful shoulder syndrome is a frequent cause of visit at physician. The development of knowledge about the anatomy and biomechanics of the shoulder allows, based on detailed examination, to precise localization of the shoulder dysfunction. Subacromial impingement syndrome is the most common cause of pain as well as of limited motion of the shoulder region. Misdiagnosis and mistreatment can lead to serious damage of the structures placed in the subacromial space including the rotator cuff, which along with the deltoid are responsible for movements of the upper limb in the shoulder joint. If not taken seriously, the problem can cause irreversible damages which will result in pain and limitations of upper limb movements.

[Distal radius fractures]. / Zlamania nasady dalszej kosci promieniowej.

Distal radius fractures are most common bone fractures. Incidence rate of the distal radius fractures are 2 per 1000 person-years. Complicated morphology and biomechanics of the fracture and high percentage of complications cause many clinical problems in the course of treatment. Detailed examination and appropriate choice the method of treatment allows to reduce the complications rate. Despite of 200 years research distal radius fractures are still great clinical problem.

NO and PGI(2) in coronary endothelial dysfunction in transgenic mice with dilated cardiomyopathy.

OBJECTIVE: The aim of the present work was to analyze coronary endothelial function in the transgenic mouse model of dilated cardiomyopathy (Tgalphaq*44 mice). METHODS: Coronary vasodilatation, both NO-dependent (induced by bradykinin) and PGI(2)-dependent (induced by acetylcholine), was assessed in the isolated hearts of Tgalphaq*44 and FVB mice. Cardiac function was analyzed in vivo (MRI). RESULTS: In Tgalphaq*44 mice at the age of 2-4 months cardiac function was preserved and there were no alterations in endothelial function. By contrast, in Tgalphaq*44 mice at the age of 14-16 months cardiac function was significantly impaired and NO, but not PGI(2)-dependent coronary function was altered. Interestingly, the basal level of PGI(2) in coronary circulation increased fourfold as compared to FVB mice. Cardiac O(2) (-) production increased 1.5-fold and 3-fold in Tgalphaq*44 vs. FVB mice at the age of 2-6 and 14-16 months, respectively, and was inhibited by apocynin. Interestingly, inhibition of NADPH oxidase or NOS-3 normalized augmented PGI(2) production in Tgalphaq*44 mice. There was also an increased expression of gp91phox in Tgalphaq*44 vs. FVB hearts, without evident alterations in the expression of COX-1, COX-2, NOS-3 and PGI(2)-synthase. CONCLUSIONS: In the mouse model of dilated cardiomyopathy, endothelial dysfunction in coronary circulation is present in the late but not the early stage of heart failure pathology and is characterized by a decrease in NO bioavailability and a compensatory increase in PGI(2). Both the decrease in NO activity and the increase in PGI(2) activity may result from excessive O(2) (-) production by cardiac NADPH oxidase in Tgalphaq*44 hearts.

Results of operative treatment of unstable distal radius fractures using percutaneous K wire fixation.

BACKGROUND: Distal radius fractures are a serious clinical problem. The evaluation of fracture stability and selection of a treatment method are of key importance for treatment outcomes. Purpose of the study. The study evaluated the outcomes of treatment of unstable distal radius fractures using percutaneous K wire fixation. MATERIAL AND METHODS: A total of 112 patients with confirmed unstable distal radius fractures were treated by percutaneous K wire fixation. Fractures were classified according to the AO/ASIF classification. Functional outcomes were evaluated with the Gartland-Werley scale as well as the Disabilities of the Arm, Shoulder and Hand (DASH) scale. Radiological outcomes were evaluated with the Lidstrom scale. RESULTS: The mean overall DASH score was 16.5. A scoring system based on the Gartland-Werley scale rated the outcomes as excellent and good in 95 (84.7%) patients, fair in 14 (12.5%) and poor in 3 (2.8%). Lidstrom radiological scores revealed 89 (79.5%) excellent and good results, 14 (12.5%) fair results and 9 (8%) poor results. CONCLUSION: Treatment of unstable distal radius fractures with percutaneous K wire fixation produces good results in patients with fracture types A2, A3, B1, B2, C1, and C2.

Functional magnetic resonance imaging within the rat spinal cord following peripheral nerve injury.

Functional magnetic resonance imaging (fMRI) was used to detect the effects of graded peripheral nerve injury at the spinal level. Graded peripheral nerve injury in rats was accomplished by transection of nerves entering the spinal cord at the L3 and L4 levels of the spinal cord segments. Electrical stimulation of the hindpaw was used to elicit activity within the spinal cord. The stimulation experimental paradigm consisted of 62 functional images, 5 slices each, with a total of 3 rest and 2 stimulation periods. A 9.4 T MRI system and a quadrature volume rf coil covering the lumbar spinal cord were used for the fMRI study. Sets of fast spin echo images were acquired repeatedly following sham preparatory surgery under control conditions and in rats following sham surgery (pre nerve cut), followed by L3 nerve and then L4 nerve section. In rats with sham surgery, there was a significant activation within the dorsal horn of slices corresponding to L3 and L4 spinal cord segments. Following section of the L3 nerve, there was a reduction in the number of active voxels in the L3 and L4 spinal cord segments. The activation was reduced further by sectioning of the L4 nerve. Thus, following an increasing loss of axonal connections to the spinal cord, there was a decreasing number of active voxels within the spinal cord. The results demonstrate that spinal fMRI in the rat has sufficient sensitivity to detect within the spinal cord the effects of a graded reduction in peripheral connectivity.

Application of linear discriminant analysis in prostate cancer research by synchrotron radiation-induced X-ray emission.

The ability to visualize an object of interest is one of the cornerstones of advancement in science. For this reason, synchrotron radiation-induced X-ray emission (micro-SRIXE) holds special promise as a imaging technique in structural biology, biochemistry, and medicine. It gives the possibility to image concentration of most of the elements in a sample at high space resolution. Statistical analysis of data obtained for samples of prostate tissues in an experiment at L-beam line HASYLAB (Hamburg, Germany) is presented in this paper. The regions for the measurements were selected according to the histological view of the sample. By histological examination, samples were divided into five groups (from healthy to Gleason4, most advanced stage of cancerogenesis). Data obtained in micro-SRIXE experiments on prostate cancer samples provide information about concentrations of certain elements in these groups. The rising problem is to find out concentrations of which elements allow the researcher to discriminate between different (early mentioned) groups. Linear discriminant analysis, a basic technique for feature extraction, was used in statistical analysis of the data. Our results indicate that the use of synchrotron radiation and discriminant analysis in the study of prostate cancer tissues provide information that can be key to better understanding of biomolecular functions.

[Long-term results of rectal tumors treatment by transanal endoscopic microsurgery (TEM)]. / Odlegle wyniki leczenia guzów odbytnicy sposobem przezodbytniczej mikrochirurgii endoskopowej (TEM).

UNLABELLED: Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for excision of selected benign and malignant rectal neoplasmas. The aim of this study was to assess the long-term results after benign and malignant rectal lesions excision using TEM. MATERIAL AND METHODS: Between December 1998 and October 2005 37 patients were operated on using TEM. Median follow-up was 3.5 years (range 1-5 years). There were 9 (33.3%) women and 18 (66.7%) men with a median patient age of 75 years (range 38-83 years). 27 patients were included into this study. RESULTS: One patient has still incontinent. There have been two local recurrences and liver metastasis in one patient. Two patients have had stricture of the rectum. One patient died because of heart attack. 21 (77.7%) of patients were satisfied with treatment. CONCLUSION: TEM is a safe, effective treatment for selected cases of benign lesions and some cases of early stage rectal cancer. Long-term results and a prospective randomized trial are needed.

[Bilateral posterior thoracoscopic splanchnicectomy in a face-down position in the management of chronic pancreatic pain]. / Obustronna tylna torakoskopowa splanchnicektomia w uloieniu brzusznym w leczeniu przewleklego bólu trzustkowego.

UNLABELLED: Abdominal pain is the primary symptom in most patients with chronic pancreatic diseases. Many authors have reported that thoracoscopic splanchnicectomy is a effective and recognize method for relief of chronic pain due to pancreatic cancer and chronic pancreatitis. Time ago only few authors used bilateral toracoscopic splanchnicectomy in one session because they observed side effects as transient orthostatic hypotension and/or diarrhea. The aim of this study was retrospective analysis of two methods of the bilateral thoracoscopy splanchnicectomy at one session. We comparsion operation's time, intraoperative and postoperative complication, hospitalization and evaluate pain intensity in patients with intractable pain due to advanced pancreatic cancer and chronic pancreatitis. MATERIAL AND METHODS: The study group comprised 94 patients, aged 26-69 years operated with bilateral thoracosopic splanchnicectomy at one session approach between years 1997-2006. There were two groups. First (I group) for operated patients in thoracotomy position with changed the position of patients at the same procedure and second (II group) for posterior thoracoscopic approach with the patient in a face-down position. In all patients evaluated operation's time, intraoperative and postoperative complication and pain intensity before and for 6 months after the thoracoscopic splanchnicectomy. RESULTS: The mean operating time in the I group was 58.3 min. and the II group was 43.5 min. (p < 0.05). There were no intraoperative and postoperative complications, only 16 patients I group and 3 patients II group had intercostal neuralgia after operation. The mean hospitalization's time in all patients were 1.3 day. In all patients pain was reduced significantly after the operation and during postoperative follow-up. CONCLUSION: Posterior thoracoscopic splanchnicectomy approach with the patient in a face-down position is a save, minimally invasive and reduce operation time procedure.

[Late complication of endoscopic sphincterotomy]. / Odlegle powiklanie endoskopowej sfinkterotomii.

Endoscopic sphincterotomy and stone extraction has become method of choice in the treatment of residual lithiasis after cholecystectomy. Then safe endeavour and effective, yet despite many advantages possible complications are. The paper presents a rare case endoscopic sphincterotomy under form of gigantic abscess of extraperitoneal space from consequent sepsis and death of patient.

Early results of surgical treatment for carpal tunnel syndrome using a single-portal endoscopic method.

Background. Carpal tunnel syndrome, the most common peripheral neuropathy, is caused by increased carpal tunnel pressure and decreased carpal tunnel volume. The aim of our study was to evaluate early results in single-portal endoscopic carpal tunnel release for the surgical treatment of carpal tunnel syndrome. Material and methods. The population included 67 patients with 80 hands operated using single-portal endoscopic carpal tunnel release. The sample included in this study consisted of 45 patients (67% of the total) and 56 hands (70%). In order to assess surgical outcome, we used the patients' subjective evaluation, the results of the Carpal Tunnel Syndrome Symptom Severity Scale and the Carpal Tunnel Syndrome Functional Status Scale, data acquired during anamnesis and physical examinations, and the results of electromyography tests. Results. In 49 cases (88%) the results were rated subjectively as good or excellent, in 6 cases (11%) satisfactory, and in 1 case (2%) unsatisfactory. At follow-up 12 months after surgery the results from the Carpal Tunnel Syndrome Symptom Severity Scale ranged from 1.2 to 3.64 (mean 1.55), and on the Carpal Tunnel Syndrome Functional Status Scale from 1.12 to 3.71 (mean 1.66). Conclusions. Single-portal endoscopic carpal tunnel release gives good results in the surgical treatment of carpal tunnel syndrome among patients diagnosed with grade I or grade II CTS, and in those groups of patients for whom revision surgery is not planned, tenosynovectomy is not indicated, and there is no need to inspect the motor branch of the median nerve.

[Evaluation of hand function and symptom severity among patients after endoscopic carpal tunnel release]. / Ocena funkcji reki i stopnia nasilenia objawów u chorych po uwolnieniu nerwu posrodkowego na poziomie nadgarstka metoda endoskopowa.

The aim of the study was to evaluate function of hand and symptom severity after endoscopic carpal tunnel release. The examined material in this study comprises 45 patients (56) hands operated with single-portal endoscopic method. In order to evaluation outcomes of treatment Carpal Tunnel Syndrome Symptom Severity Scale (CTS SSS), Carpal Tunnel Syndrome Functional Status Scale (CTS FSS) and clinical examinations outcomes were used. Average results of preoperative questionnaires were equaled respectively: CTS SSS--2.9 and CTS FSS--2.8. Average results of postoperative questionnaires were equaled respectively: CTS SSS--1.5 and CTS FSS--1.7. Statistical analysis has shown significantly better results of CTS SSS and CTS FSS questionnaires, among patients with positive Tinel's Test and without thenar atrophy found before operation. Results of research based on questionnaires and clinical examinations, proved fast return of function of hand and decrease symptoms severity after endoscopic carpal tunnel release.