An antero-lateral submandibular approach to segment C2-C3 of the cervical spine

This article presents the antero-lateral submandibular surgical approach and the application of cervical plates of stabilization of post-traumatic C2-C3 spondylolisthesis. Neither the posterior approach, which does not give an acceptable operating area, nor the anterior approach, which is dangerous and disfiguring for the patient, give a satisfactory outcome in such cases. Results are presented and discussed from two typical operations performed by the author with the antero-lateral submandibular approach and the application of a cervical plate. The article describes the advantages of the author's own modification of the antero-lateral approach, and the application of cervical plates for stabilizing post-traumatic spondylolisthesis at such a high level in the cervical spine, which allows for almost immediate post-surgical mobilization of the patient and effective rehabilitation.     

Structure-activity relationships in the acronycine series

Acronycine is active against a broad spectrum of solid tumors. Structure activity relationships demonstrated the crucial role of the 1,2-double bond. A hypothesis of bioactivation into 1,2-epoxide led to the development of a series of 1,2-dihydroxy-1,2-dihydroacronycine and 1,2-dihydroxy-1,2-dihydrobenzo[b]acronycine diesters that exhibited an increased potency when compared with the parent compound.     

Planning rehabilitation with elements of active movement for brain-damaged patients

Background. Much research has been done in recent years on optimizing rehabilitation by increasing effectiveness, shortening hospitalization, and reducing cost. One of the more interesting solutions that has been proposed is rehabilitation with elements of active movement, conducted on the basis of strategic planning in cooperation with the patient. The goal of the present study was to evaluate the effectiveness of the strategic approach to the motor rehabilitation of persons with brain damage. Material and methods. We studied 36 brain-damaged patients, divided into two groups paired for age and gender. In the control group of 18 persons, traditional, comprehensive rehabilitation was used. The experimental group was rehabilitated based on an individualized strategic plan with motor elements. Outcome was evaluated by clinical observation, the Polish version of the Functional Independence Measure (FIM), and the Self-Evaluating Scale of Progress in Rehabilitation. Results. Progress was seen in both groups on many FIM parameters, which points to the effectiveness of the techniques used in the standard program; however, the results in Group E were significantly better in terms of functional independence and psycho-social functioning. The patients from Group E were much more satisfied with what they had accomplished than the controls. Conclusions. Rehabilitation planning with elements of active movement maximizes the benefits obtained from the methods used. The strategic approach helps the patient become more independent, increases patient satisfaction, and improves motivation to take an active part in exercises.     

Differential diagnosis of frontal syndrome in patients with closed-head injuries

Background. A common sequela of head injury is "frontal syndrome", consisting in characteristic neurobehavioral disturbances. However, there is no ecologically valid research tool that would clearly indicate the presence of this syndrome. The goal of this article is to evaluate the authorized the Polish version of the Frontal Behavioral Inventory (FBInv), used to differentiate fronto-temporal dementia (FTD) from other dementias. Material and methods. The research involved 95 patients treated at the centers represented by the authors, divided into 3 groups: CHI, consisting of 39 patients with traumatic frontal lobe injuries; FTD, consisting of 28 patients with fronto-temporal dementia; and a control group of persons with post-traumatic depression without injury to the frontal lobes. The results were based on data obtained from caregivers in 24 categories of patient behavior covered by the FBInv. Results. We found important differences in total scores between patients with frontal syndrome from groups CHI and FTD, as against patients with post-traumatic depression. There are also noticeable differences between patients in group FTD and group CHI in terms of scores on particular test items. Conclusions. The FBInv in the authorized Polish version is both sensitive and specific in measuring neurobehavioral disturbances occurring in patients with post-traumatic damage to the changes in the behavioral and personality of these patients with the passage of time since injury or onset should be the topic of further research.     

Irinotecan in the treatment of advanced colorectal cancer in patients pretreated with Fluorouracil-based chemotherapy: a study to determine recommendable therapeutic dosage

Because no consensus exists regarding recommendable dose levels for irinotecan, an intrapatient dose escalation phase I-II study was initiated in previously treated patients with colorectal cancer. Survival was a secondary endpoint. Thirty-five consecutive patients with progressive disease after 5-fluorouracil-based chemotherapy were enrolled to receive irinotecan starting from 250 mg/m2/3 weeks and rising to currently used therapeutic doses. In total, 162 cycles were administered. The median tolerable dose was 250 mg/m2. Twelve patients (34%) were unable to tolerate doses greater than 250 mg/m2, 10 patients (28%) presented toxicity at 250 mg/m2 and 2 patients tolerated only 200 mg/m2. Three patients (9%) had partial response. The major adverse reactions were grade III-IV diarrhea, grade II-III nausea/vomiting, grade II-III neutropenia, and grade II-III anaemia in 28%, 48%, 11%, and 17% of the patients, respectively. Median survival time and time to progression were 8 and 3 months, respectively. The current irinotecan dose of 350 mg/m2/3 weeks appears unacceptably toxic and, hence, a lower dose needs to be considered. The response rates obtained are similar to the results observed in phase III studies, and its activity appears not to be adversely affected with this treatment scheme.     

"Towards a Better Life": a program of comprehensive rehabilitation for elderly patients following revision hip arthroplasty

Introduction. The aim of the research was to evaluate the quality of life of patients recovering from revision hip arthroplasty, who underwent rehabilitation under the "Towards a Better Life" program (TBL). In the TBL Program, appropriate physical exercises, relaxation techniques, seminars, and panel discussions are combined to support general improvement in both physical and psychological condition, thus improving the patients' quality of live.
Material and methods. The effectiveness of the TBL approach was evaluated in a clinical experiment involving 36 patients recovering from revision hip arthroplasty, treated under the standard rehabilitation program in general use at the centers represented by the authors. The patients were divided into two equal groups, matched by age and sex: an experimental group E (n = 18), with patients who received additionally the "Towards a Better Life" Program, and a control group K (n = 18), consisting of patients who did not receive this program. The methods used to evaluate the outcome of rehabilitation included clinical interview and observation, the Medical Outcomes Study (MOS-100) and the Self-Evaluating Quality of Life Scale (QOL). The patients were tested before rehabilitation commenced and re-tested two months later.
Analysis of results. On the Physical Index of the MOS-100 scale considerably greater progress was observed in patients from Group E in terms of reduced pain, increased coordination and fluency of movement, improved respiratory capacity, regulation of blood pressure and pulse, functioning of the digestive system, reduced body weight, and improved walking distance. In this group somewhat greater improvements were noted on the Psychological Index of the MOS-100, especially in cognitive functions (perception and attention) and emotional factors (increased satisfaction with life, reduced anexiety, depression, and irritability). The QOL parameters most sensitive to the difference between the TBL Program and the standard program were pain management, independence and self-care, and especially improved self-image and reduced anxiety. The improvements noted by Group E were in many subtest two or three times higher than in Group K.
Conclusions. The greater improvements recorder by patients participating in the "Towards a Better Life" Program in all measured parameters indicates that the program is highly effective in comparison to the standard model. The patients from Group E were much more satisfied with the results they had achieved in rehabilitation, and attained a higher degree of independence and self-determination. The TBL Program can be used to improve the quality of life of patients recovering from revision hip arthroplasty.     

Dry powder inhalation of antibiotics in cystic fibrosis therapy: part 2. Inhalation of a novel colistin dry powder formulation: a feasibility study in healthy volunteers and patients.

The aim of the present study was to perform a proof of principle study with a new colistin dry powder inhalation system in six healthy volunteers and five patients with cystic fibrosis. All subjects were asked to inhale 25 mg colistin sulfate dry powder. The patients were also asked to nebulize 160 mg colistin sulfomethate as a solution. Colistin serum concentrations were determined as an indirect parameter to compare both forms of administration. Pulmonary function tests were performed. Peak serum colistin concentrations ranged from 14 to 59 microg/l in volunteers after inhalation of 25 mg as dry powder. In patients, peak concentrations ranged from 18 to 64 microg/l after nebulization of 160 mg colistin sulfomethate solution and from 77 to 159 microg/l after inhalation of 25 mg colistin sulfate dry powder. Pulmonary function tests were not significantly different after inhalation of the dry powder by the volunteers nor after nebulization of the solution by the patients. In some patients a decrease in pulmonary function and moderate to severe cough was observed after inhalation of the dry powder. The new colistin inhaler provides an attractive alternative for nebulized colistin and was highly appreciated by the patients. The decrease in pulmonary function and cough in patients is a drawback, which may be overcome by dose reduction and a further improvement of the new dosage form.