The influence of selected prognostic factors on the results of combined treatment of invasive carcinoma of the cervix on stage IB and stage IIA

This is a retrospective analysis of 180 patients treated by combination of radical surgery and radiotherapy for invasive carcinoma of the cervix in stage IB and IIA. The influence of the following prognostic factors on the survival has been evaluated: the presence of pelvic lymph node metastases, histopathology of the tumor, the size of the primary tumor, presence of vascular space invasion and surgical margines. Nodal status has proved to be the most important prognostic factor: 91% of patients without pelvic lymph node metastases survived 5 years, 57% with up to two metastases and 36% with three and more metastases to the pelvic nodes. A significantly worse prognosis has also been observed in patients with adenocarcinoma of the cervix, and with the size of the tumor of more than 2 cm.     

Hypoglycemia in newborn of the diabetic mother in relation to some indicators of perinatal hypoxia

DESIGN: To examine whether perinatal hypoxia increases the risk of occurrence of hypoglycaemia--between first and second hour of life--in newborn of the diabetic mother. MATERIAL AND METHODS: The study material consisted of 151 newborns born to 58 pregestational and 93 gestational diabetes mothers. The occurrence of hypoglycaemia was examined in accordance with some perinatal hypoxia indicators such as: 1 and 5 minutes Apgar scores, umbilical arterial blood gas analysis and cord blood erythropoietin (EPO) level. RESULTS: Newborns of the diabetic mothers in whom hypoglycaemia was recognised had lower 1 minutes Apgar scores, lower pH values, higher pCO2 values and higher EPO levels than those, in whom normoglycaemia was recognised. CONCLUSIONS: Low 1 minutes Apgar scores and occurrence of even mild perinatal hypoxia are factors increasing the risk of hypoglycaemia in the group of newborns of the diabetic mothers in the time between first and second hour of life.     

Prospective neurological analysis of development of children of mothers with IDDM

Aim of the study was early diagnosis of CNS damage and dysfunction in the progeny of women with diabetes type 1 (DM1). Interdependencies between the course of diabetes in mothers and fetal-perinatal complications and neurological state of the progeny were also analysed. 35 children of mothers with DM1 and 109 in control group underwent neurological examinations at the age of 3, 6, 9, 12 and 18 months. RESULTS: In the group of children of DM1 mothers four had symptoms of CNS damage such as cerebral palsy or psychomotor delay. In the remaining 9 children so-called "soft" neurological signs or minor neurological dysfunction were found. In control group 1 had a light form of cerebral palsy and 3 had symptoms of minor neurological dysfunction. The dependencies of frequency and gravity of neurological disorders in children on diabetes metabolic control and complications and hypoxemic-ischemic states, prematurity, macrosomia and hypoglycemia in newborns was observed. CONCLUSION: The symptoms of CNS dysfunctions are more frequent and more serious in children of DM1 mothers than in control group.     

The effect of selected factors on the birthweight of the newborns in gestational diabetes

Fetal macrosomia is commonly associated with gestational diabetes mellitus (GDM) which may lead to various complications. We attended to establish maternal constitutional and metabolic risk factors responsible for the genesis of macrosomia. 219 GDM mothers were divided into two groups treated by diet or insulin. This study shows that maternal glycemic status and maternal nutritional status before pregnancy are important determinants of fetal macrosomia.     

Results of six-years-term perinatal care of diabetic woman in Silesia district

Authors had retrospectively analyzed basic exponents of perinatal care of 256 pregnant diabetic woman in years 1993-1998 hospitalized and delivered in Clinic of Obstetrics and Gynaecology in the town of Bytom. Our results were very similar to the other of Referent Centres Of Technical Methods Bank Used in Diagnostic and Therapy of Diabetes: cesarean sections percentage 51.56%, 4.7% of undelivered pregnancies, 2.34% of new-born delivered with multiple congenital defaults, 17.2% of macrosomies and 39.8% pre-term deliveries were noted. Disadvantage perinatal effects in diabetic women might be reduced by very early diagnosis of diabetic and intensive biophysical and biochemical fetal care, which is strongly suggests by the authors.     

Binaural advantages in using a cochlear implant for adults with profound unilateral hearing loss

Background: Recent studies of cochlear implants (CIs) in profound unilateral hearing loss (UHL) patients have demonstrated a restoration of some binaural hearing.

Aims/Objectives: The objective was to evaluate three possible advantages of binaural hearing in CIs adult users with UHL including single-side deafness (SSD) and asymmetric hearing loss (AHL) subgroups.

Material and methods: A prospective study was conducted that included 70 sequentially implanted patients. Subgroups of these subjects included 64 with a postlingual onset of a profound hearing loss on the implanted side and 6 with a prelingual onset of that loss. Three binaural effects – redundancy, head shadow, and squelch – were evaluated.

Results: Significant differences between the ‘CI on’ and ‘CI off’ conditions were found for all three binaural effects for the study group as a whole and for the postlingual subgroup. However, results for the subjects in the prelingual subgroup did not demonstrate any of the binaural advantages.

Conclusion and significance: Patients with a postlingual onset of a profound hearing loss in one ear and normal hearing or only a moderate loss in the other ear are able to make the effective use of a CI in the profound-loss ear in conjunction with acoustic stimulation of the other ear.     

The long-term results of decompression and anterior lumbar interbody fusion for the treatment of degenerative lumbar spondylolisthesis]

In this paper we reviewed 31 patients who had been treated surgically for lumbar degenerative spondylolisthesis. They were operated between 1990-1996. The decompression and anterior lumbar interbody fusion with use of autologous bone graft,was performed in all of them. The duration of follow-up ranged from 12 to 6 years. The outcome was assessed using rating system of Prolo and VAPS. The disc high, degree of slippage, segmental lordosis, before surgery, after 6 weeks and at the time of final follow-up were measured on the radiographs. In all cases spinal fusion were achieved. A significant decrease in radicular pain and low back pain was seen but the relation between clinical and radiological outcomes was not observed.     

Aortoventriculoplasty and left ventricle function: long-term follow-up.

OBJECTIVE: Depressed cardiac function after aortoventriculoplasty is well known during the postoperative period. Little data exist concerning the long-term follow-up. The aim of this study is to determine whether septal incision has any permanent effect on the left ventricle function. METHODS: From 1988 to 2002, 45 patients received aortic mechanical prosthesis. These patients were divided into two groups. Group A consisted of 26 patients 5-18 years old, who underwent simple aortic valve replacement. Group B consisted of 19 patients 4-20 years old, who underwent the Konno procedure. Systolic and diastolic functions of the left ventricle were analyzed using echocardiography. For the systolic function, the following parameters were assessed: pressure gradient between left ventricle and ascending aorta, shortening and ejection fraction of the left ventricle. For the diastolic function, left ventricle-filling parameters were assessed: ratio of early to late filling velocity, deceleration slope of the early filling velocity and left ventricular isovolumetric relaxation time. Furthermore the percentage fraction of the aortic valve index (AOVI%) was calculated and compared between these two groups. RESULTS: After the surgery in group A, AOVI% dropped from 110+/-21 to 98+/-11%, while in group B it increased from 82+/-16 to 114+/-11%. As a result a higher residual pressure gradient across the aortic valve was noted in group A: 21.26+/-15 as compared to 11.17+/-5 mmHg in group B. A mean pressure above 30 mmHg appeared in group A 2 years after the surgery, while in group B this was obtained after 6 years. As for the diastolic function no significant difference was noted between these two groups. Overall there was one late death in group A, and in group B two early deaths, two reoperations because of excessive drainage and in two patients permanent pacemakers had to be implanted. CONCLUSIONS: Improvement of the systolic function after the surgery was noted in both groups. In patients with low AOVI%, postsurgical pressure gradient, either residual or recurrent, appeared during the follow-up. As for the septal incision, it may have some transient effects on the left ventricle function in the postoperative period, but no permanent sequelae were observed in the long-term follow-up.     

Usefulness of distraction osteogenesis in the treatment of knee arthrosis]

AIMS: The purpose of this study is the assessment of efficiency of distraction osteogenesis (DO) as a method of operative treatment of knee arthrosis with co-existent varus deformity. MATERIAL AND METHODS: Authors undertook an attempt of evaluation of results of tibial corticotomy in 21 patients (25 operated knee joints) treated in Orthopaedic Clinic of Wroclaw Medical University in years 1995-2001, with the use of circular, external Ilizarov's fixator. All the operated patients underwent corticotomy of proximal tibial metaphysis followed by slow axis correction and bone regenerate formation started at 7th postoperative day. In orthopaedic examination functional evaluation of knee joint with modified point scale according to Ranawat (HSS-score) there were taken into account. In rentgenometric examination the limbs axis in the frontal plane and joint space morphology according to Ahlback were evaluated. RESULTS: The results in our group of patients were very encouraging. Accordingly to Ranawat scale, in majority of patients assessed before the treatment as poor and fair moved to group assessed as fair and good and even excellent. We observed decelerated regenerate formation and remodeling probably caused by advanced age of patients in 6 cases. In 3 cases persistent lose of entire correction was observed. CONCLUSIONS: In author's opinion DO as a method of operative treatment of unicompartmental knee arthrosis could be advocated as alternative method to traditional tibial osteotomy considering its biological effect stimulating regeneration of all tissues including cartilage even in advanced unicompartmental arthrosis.