RESUMEN
Hand Trauma Severity Scale (HTSS) was created on the basis of our study on 1199 patients who were treated because of the hand injuries in the Second Chair of Surgery Jagiellonian University in Krakow in years 1987-2000. (last examination in 2010, follow-up: 11 to 23 years, mean follow-up: 16 years). Hand Trauma Severity Scale (HTSS) has been created based on We looked at the range of injury, likely total length of treatment, final functional result and possible amount of posttraumatic disability. Created HTSS scale was compared to Hand Injury Severity Score (HISS) and their statistically significant correlation (p < 0,001) was found. We have also found statistically significant correlation between the severity evaluated with HTSS and the circumstances of traumas, their direct cause, necessity of hospitalization after primary reconstructive treatment and total length of treatment. Distant results of treatment such as resuming of previously performed work and permanent posttraumatic disability also correlated with the severity of hand injuries measured with scale described in this study.
Asunto(s)
Traumatismos de la Mano/clasificación , Puntaje de Gravedad del Traumatismo , Actividades Cotidianas , Traumatismos de la Mano/fisiopatología , Hospitalización/estadística & datos numéricos , Humanos , Evaluación de Capacidad de TrabajoRESUMEN
BACKGROUND: Proinflammatory cytokines play a fundamental role in the local and systemic inflammatory responses in the initial stages of acute biliary pancreatitis (ABP) and in the development of severe forms of the disease. OBJECTIVES: The aim of the present study was to assess the systemic release of proinflammatory cytokines and to characterize differences between patients with mild ABP (MABP) and severe ABP (SABP). PATIENTS AND METHODS: In the current study, 54 patients with MABP were compared with 14 patients with SABP. Serum levels of tumour necrosis factor-alpha, interleukin (IL)-1beta, IL-6, IL-8 and IL-12p40 were measured every second day after admission for one week. RESULTS: The tumour necrosis factor-alpha level was similar in all days of analysis in patients with MABP but was lower compared with SABP patients. The level of IL-1beta was higher at admission in patients with MABP. The level of IL-6 peaked on admission day in both groups, but in patients with SABP, the obtained values were higher. The level of IL-8 on admission day was slightly higher in patients with MABP and systematically decreased when measured on the following days (the third, fifth and seventh days of the study). An increased level of IL-8 during the third, fifth and seventh days of the investigation was seen in SABP patients. The level of IL-12p40 was slightly higher in patients with MABP on the day of admission. CONCLUSIONS: The levels of some proinflammatory cytokines are higher in patients with SABP than in patients with MABP. The most consistent difference between the two groups was that the levels of IL-6 were significantly higher in patients with SABP throughout the study. Serum concentration of IL-6 may be helpful as a marker of severity and outcome of ABP.
Asunto(s)
Citocinas/sangre , Pancreatitis/sangre , Adulto , Anciano de 80 o más Años , Femenino , Humanos , Subunidad p40 de la Interleucina-12/sangre , Interleucina-1beta/sangre , Interleucina-6/sangre , Interleucina-8/sangre , Masculino , Persona de Mediana Edad , Pancreatitis/fisiopatología , Índice de Severidad de la Enfermedad , Factor de Necrosis Tumoral alfa/sangreRESUMEN
Comparative analysis was done between a group of 193 patients operated on for mechanical bowel obstruction at the end of the XIX century (prof. A Obalifinski's clinical material), and a group of 207 patients with the same condition operated on between 1.01.1999 - 31.12.2003 (own clinical material). Both groups were operated on at the same surgical institution. A hundred years ago, and at present mechanical bowel obstruction has been appearing (depending on a patient's sex), in the 1:1 relationship. In both analysed periods two third of the patients developed small bowel obstruction, and one third large bowel obstruction. At the end of the XIX century mean age of the operated patient was 41 years. It was equal to the mean survival time span for the general population at that time. The patients operated on at present were about 25 years older. However their mean age is significantly lower compared with the actual mean survival time span for the general population observed now in Poland. In small bowel the main cause of obstruction has still been an incarcerated abdominal hernia (increase from 30.7% up to 55%), followed by intraperitoneal adhesions (increase from 29.5% up to 34.5%). However their etiology has changed, recently all of them are postoperative adhesions. At the end of the XX century we observed significant drop (from 16.8% to 2.7%) in strangulation of the small bowel mesentery as a cause of obstruction. In case of large bowel during the last century there was a definitive change in frequency of different etiological factors causing obstruction. In the XIX century 72% of them was caused by mesentery strangulation of sigma or cecum. whereas at present over 80% of them is caused by cancer. We presented Prof. A. Obalinski's and his associates scientific output, as they were genuine precursors of mechanical bowel obstruction surgery in Poland.
Asunto(s)
Obstrucción Intestinal/historia , Obstrucción Intestinal/cirugía , Adulto , Anciano , Procedimientos Quirúrgicos del Sistema Digestivo/historia , Femenino , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Obstrucción Intestinal/fisiopatología , Masculino , Persona de Mediana Edad , PoloniaRESUMEN
The study was based on 1199 patients consecutively treated for hand injuries in the Second Department of Surgery of the Jagiellonian University in Krakow between the years 1987 and 2000. Three hundred and twenty of these patients (26.6%) had consumed alcohol several hours before an accident. Data collected from an interview with the patient and a doctor on duty were used in the study. Routine tests for blood alcohol concentration were not carried out. Young men (89.3%), mostly manual workers (74.3%) (p<0.001), constituted the majority of patients in the alcohol group. They were younger on average (p<0.001) than sober patients. In most cases, the accident had happened at home (65.9%) (p<0.001) and the main cause of injury was a cut with glass (p<0.001). Despite only minor injuries they were treated in hospital due to their state of intoxication. The degree of hand disability was higher (p<0.05) than with sober patients. The average cost of treatment in a state of intoxication was more than twice as high as the cost of treatment in sober patients. Alcohol-related hand injuries present a major medical and socioeconomic problem.
Asunto(s)
Intoxicación Alcohólica/complicaciones , Traumatismos de la Mano/etiología , Accidentes/economía , Adulto , Factores de Edad , Intoxicación Alcohólica/economía , Femenino , Traumatismos de la Mano/economía , Traumatismos de la Mano/terapia , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Polonia , Factores de Riesgo , Clase Social , Índices de Gravedad del TraumaRESUMEN
The original Hand Disability Score (HDS) questionnaire which subjectively evaluates the quality of hand function in 25 one- and two-handed daily living activities was developed. The strict correlation (p < 0.001) between HDS and both severity of injury and objectively measured hand impairment was confirmed. The HDS may be used as a single estimation of hand function after treatment or as an evaluation of the progress of rehabilitation procedures.