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Rana rehabilitacija pacijenata kod cerebralnih aneurizmi

Early rehabilitation in patients with cerebral aneurysms

SAŽETAK

UVOD: Cerebrovaskularne bolesti (CVB) uz kardiovaskularne bolesti (KVB) i maligne bolesti su najčešća oboljenja muškaraca i žena u razvijenom svijetu. Nalaze se na trećem mjestu po smrtnosti, a na prvom mjestu po invalidnosti. Pod pojmom CVB podrazumevaju se svi poremećaji u kojima je dio mozga prolazno ili trajno oštećen ishemijom ili krvarenjem i kod kojih je jedan ili više krvnih sudova mozga primarno oštećen patološkim procesom.

CILJ RADA: je ustanoviti utječe li rani početak rehabilitacije oboljelih od cerebralnih aneurizmi na: pojavu komplikacija, na dužinu akutnog liječenja i nastavak liječenja u drugim ustanovama.

METODE ISTRAŽIVANJA: Ispitivanje je retrospektivno. Studija obuhvata period od 01.12.2013.godine do 01.07.2014. godine. U istraživanje je uključeno 50 pacijenata.

U istraživanje su uključeni svi pacijenti Klinike za neurohirurgiju KCUS koji su hospitalizirani u gore navedenom periodu.

REZULTATI I ZAKLJUČCI: Analizom spolne distribucije ispitanika ustanovili smo da je statistički značajniji broj pacijenata ženskog spola 78%, u odnosu na pacijente muškog spola kojih je bilo 22%. Kada je u pitanju starosna struktura ispitanika, najveći broj ispitanika spada u dobnu skupinu od 46-55 godinu njih 44% (22), u dobnim skupinama od 36-45 godina i 56-66 godina imamo po 9 pacijenta (18%), u dobnim skupinama od 67-75 i 76-85 godina imamo po 1 pacijenta.

Prema zastupljenosti dijagnoza u našem istraživanju utvrdili smo sljedeće. Najveći broj dijagnoza je Aneurisma rupturata njih ukupno 38 (76%), zatim Aneurisma a Basilaris 9 (18%), Aneurisma Gigantea 2 (4%) i 1 Aneurisma a Ophtalmicae 2 (4%).

KLJUČNE RIJEČI: rehabilitacija, cerebralne aneurizme, cerebrovaskularne bolesti, prevencija komplikacija

SUMMARY

INTRODUCTION: Cerebrovascular diseases along (CVB) with cardiovascular diseases (KVB) and malignant diseases are the most common diseases of men and women in the developed world.There are third in mortality, and in the first place bydisability.The term CVB means all disorders in which part of the brain is transiently or permanently damaged byischemia or bleeding and in which one or more blood vessels of the brain primarily damaged by pathological process.

AIM OF THE WORK: to determine the influence of the early start of rehabilitation of patients with cerebral aneurysms on: currence of complications, the length of the acute treatment and continuation of treatment at other institutions.

METHODS OF SEARCHING: The study has a retrospective.The study included the period from 01.12.2013. to 01.07.2014.years. The study included 50 patients. The study included all hospitalized patients of the Department for Neurosurgery KCUS in the above mentioned period.

RESULTS AND CONCLUSIONS: The analysis of sex distribution of subjects showed that there is a statistically significant higher number of women (78%), compared to the number of male patients (22%).When it comes to the age structure of the respondents , most of the respondents belong to the age group of 46-55 years old- 44% (22), in the age groups of 36-45 years old and 56-66 years old there is 9 patients in each (18%), in the age groups of 67-75 years old and 76 -85 years old we have 1 patient.

We conclude that the majority of diagnoses in our study is Aneurysma rupturata with 38 (76%) cases, followed by aneurysm of the basilar artery with 9 cases (18%), Aneurisma Gigantea with 2 cases (4%) aneurysm of the ophtalmic artery with 2 cases (4%).

KEY WORDS: rehabilitation, cerebrovascular aneurysms, cerebrovascular diseases,prevention of complications

Nastavi čitati Rana rehabilitacija pacijenata kod cerebralnih aneurizmi

Rana rehabilitacija operisanih od tumora mozga

Early medical rehabilitation after neurosurgical treatment of malignant brain tumours

SAŽETAK

Aktuelni problemi neurohirurških pacijenata dovode do stvaranja funkcionalne zavisnosti različitog stepena. U procesu postoperativnog liječenja svih tumora mozga preporučuje se adekvatna fizikalna terapija i rehabilitacija u kojoj učestvuje multidisciplinarni tim.

Uvođenjem algoritma funkcionalnih-kliničkih testova možemo utvrditi stepen zavisnosti i mogućnosti uspešnijeg, bržeg i kvalitenijeg funkcionalnog osposobljavanja neurohirurških pacijenata. Prema vrsti fizikalnog faktora fizikalna terapija ima pet velikih cjelina: mehanoterapija, termoterapija, elektroterapija, fototerapija te prirodni faktori.

CILJ RADA: Cilj rada je ustanoviti utječe li rehabilitacija operisanih pacijenata sa tumorom mozga na: njihov brži oboravak, pojavu komplikacija i na dužinu akutnog liječenja

METODE RADA: Ispitivanje je retrospektivno. Studijom su obuhvaćeni neurohirurški pacijenti hospitalizirani na Klinici za neurohirurgiju Kliničkog centra Univerziteta u Sarajevu. Istraživanje je provdeno u periodu od 14.11.2013.godine do 15.04.2014. godine. U istraživanje je uključeno 50 pacijenata.

DISKUSIJA I ZAKLJUČCI: U toku našeg istraživanja imali smo 54% muških ispitanika i 46% ženskih. Najveći procenat naših ispitanika spada u starosnu skupinu od 46-55 godina, čak njih 32%. Fizikalni tretman je bio uključen kod 43 naša ispitanika (86%), dok kod njih 7 (14%) nije. Kada je u pitanju vrsta fizikalnog tretmana koja je aplicirana našim ispitanicima imamo u nejvećem broju slučajeva 67% vertikalizaciju, pasivne vježbe u 12% slučajeva, blaneofiziokineterapija u samo jednom slučaju, dok se kod 8 pacijenata (19%) fizikalni tertman odvijao na odjelu Klinike za fizijatriju.

KLJUČNE RIJEČI: neurohiruški pacijent, postoperativni tretman, fizikalna terapija, rehabilitacija

SUMMARY

INTRODUCTION: Current problems with neurosurgical patients lead to the creation of functional dependence of various degrees. In the process of post-operative treatment of brain tumors, recommendation is adequate physical therapy and rehabilitation which involves a multidisciplinary team.

By implementing the algorithm of functional-clinical tests, could be determined the degree of dependence and the possibility of more successful, faster and better functional recovery of neurosurgical patients. According to the type of physical factors, physical therapy has five large units: mechanotherapy, termote¬rapija, electrotherapy, phototherapy and natural factors.

RESEARCH OBJECTIVE: To determine does the rehabilitation of neurosurgical patients with brain tumors influence to: their faster recovery, the occurrence of complications and the length of acute treatment.

RESEARCH METHODS: The study is retrospective. The study included neurosurgical patients hospitalized in the Neurosurgical Clinic – University Clinical Center of Sarajevo. The study was conducted for the period from 14.11.2013 to 15.04.2014. The study included 50 patients.

DISCUSSION AND CONCLUSIONS: The study included 54% of male and 46% of female respondents. The largest percentage of this patients are between 46-55 years age (32%). Physical therapy treatment has been conducted on 43 respondents (86%), while on 7 respondents (14%) didn’t. Regarding to types of applied physical therapy treatments to our respondents, vertical therapy was conducted in 29 cases (67%), passive exercise therapy in 5 cases (12%), balneophysical therapy in only one case (2%), while in 8 cases (19%) physical therapy was conducted on Physical Therapy Clinic – University Clinical Center of Sarajevo.

KEY WORDS: neurosurgical patients, postoperative treatment, physical therapy, rehabilitation

Nastavi čitati Rana rehabilitacija operisanih od tumora mozga

Primjena hiperbarične komore kod patoloških promjena na perifernim krvnim sudovima

Application of hyperbaric therapy to the patients with pathological changes in peripheral blood vessels

SAŽETAK

UVOD: Primjena hiperbarične terapije je efektivna komponenta kompleksnog liječenja šećerne bolesti, ne samo u liječenju kasnih komplikacija već i u ranoj fazi bolesti. Cilj je da se spriječi razvoj hipoksije i pratećih komplikacija (mikro i makroangiopatije, polineuropatije, retinopatije i nefropatije).Terapija hiperbaričnim kisikom je relativno rijetko primjenjivan metoda liječenja iako postoje brojne studije koje dokazuju pozitivne kliničke efekte kod niza bolesti. Stoga je potrebno istražiti koliko se ta metoda primjenjuje kod nas, kod kojih bolesnika kao i kakvi efekti su zabilježeni.

CILJ RADA: Utvrditi udio odnosno zastupljenost pojedinih bolesti unutar ispitivane grupe bolesnika liječenih u hiperbaričnoj komori; Utvrditi udio bolesnika kod kojih tretman u hiperbaričnoj komori nije mogao biti primijenjen ili je morao biti prekinut zbog nuspojava.

Utvrditi dužinu tretmana ispitivane grupe; Utvrditi uspješnost tretmana.

METODE ISTRAŽIVANJA: Istraživanje je provedeno na Klinici za vaskularne bolesti UKC Sarajevo u periodu od jula do marta 2015.g. Studija je retrospektivna i obuhvatila je 119 pacijenata. Za istraživanje korištene su Historije bolesti i bolnički protokol Klinike.

REZULTATI ISTRAŽIVANJA: Od ukupno 119 pacijenata 87 su bili muškaraci (73,1%) i 32 žene (26,9%). Prosječna starost ispitanika za čitavu grupu je bila 60,12 godina, (muškaraca 60,49 a žena 59,18 godina). Od ukupnog broja tretiranih, 40 pacijenata je bilo sa dijabetičnim ulkusom ekstremiteta, ishemijski arterijski ulkus je imalo 33, a radi Morbus Buerger je tretirano 12 pacijenata. Tretirana su 34 pacijenta sa venskim ulkusom.

ZAKLJUČCI: Od ukupno tretiranih pacijentata, kod 58 je registrovano poboljšavanje stanja, kod 48 pacijenata nije bilo uočljive promjene (poboljšavanja ili pogoršavanja), dok je dok je kod samo 13 pacijenata potpuno izostao učinak hiperbarične oksigenacije.

Najbolji i statistički signifikantan efekt je postignut u tretmanu venske patologije, dok su različita stanja insuficijencije arterijske cirkulacije imale slabiji efekt, koji nije bio statistički signifikantan. Tretman u hiperbaričnoj komori se pokazao kao podnošljiv jer je kod svih ispitanika tretman proveden u planiranom trajanju.

KLJUČNE RIJEČI: hiperbarična komora, dijabetes, stopalo, oksigenacija, tretman

SUMMARY

INTRODUCTION: Application of hyperbaric therapy is an effective component of a complex treatment of diabetes. In addition of treatment of late complications, therapy is also used at early stage of the disease. The main aim of therapy is to prevent the development of hypoxia and related complications (micro and macroangiopathy, neuropathy, retinopathy and nephropathy). Hyperbaric oxygen is relatively rarely applied method of treatment, although there are numerous studies that prove the positive clinical effects in a number of diseases. Therefore, it is necessary to examine how this method is applied in our medical practice, type of treated patients and what effects have been reported.

RESEARCH OBJECTIVE: To determine the precentage and distribution of certain diseases in the studied group of patients treated by hyperbaric therapy; to determine the precentage of patients that hyperbaric therapy could not be applied or had to be interrupted because of side effects; to determine the length of the treatment of the test group; and to determine treatment success.

RESEARCH METHODS: The study was conducted at the Department of Vascular Clinic – University Clinical Center of Sarajevo, in the period from July 2014 to March 2015. The study was retrospective. The study included 119 patients. Documents used for the realization of the study are History of diseases and Vascular Clinical Protocol.

RESEARCH RESULTS: The total number of treated patients was 119, from that 87 were male (73.1%) and 32 female (26.9%). The average age of the respondents was 60.12 years (male 60.49 years and female 59.18 years). Of those patients, 40 patients with Extremity ulcer diabetic, 33 with Ischemic arterial ulcer, 12 patients with Buerger’s disease, and 34 patients with Venous ulcer.

CONCLUSION: From the total number of treated patients, in 58 patients was noted improvement in their health condition, in 48 patients was noted noticeable change (improvement or deterioration), while in only 13 patients resulted totally absent effect of hyperbaric therapy.

The most statistically significant effect is accomplished in the treatment of venous pathology, while weaker effect was noted in patients with insufficiency of arterial circulation, which wasn’t statistically significant. The treatment by hyperbaric therapy proved as a tolerable method of treatment, because in all treated patients treatment carried out in a planned duration.

KEY WORDS: hyperbaric therapy, diabetes, foot, oxygenation, treatment

Nastavi čitati Primjena hiperbarične komore kod patoloških promjena na perifernim krvnim sudovima

Reduction of pain in patients with lumbar syndrome

SUMMARY

Low back pain (LBP) can interfere with an individual’s ability to work, have a meaningful and active social life, and negatively affects overall quality of life. In recent years, new approaches have been considered as alternative treatments for LBP. Spinal manipulative therapy (SMT) is one of these new approaches to acute LBP treatment. Still, recent studies have found contradicting results in terms of the effectiveness of such alternative therapies. This study aimed to compare the effect of SMT in combination with standard physical therapy (SPT) versus SPT alone to treat chronic LBP. A randomized, controlled, parallel group trial was undertaken. A total of 66 subjects were enrolled in the study. The intervention consisted of adding two consecutive SMT two days apart followed by SPT for a total period of one month. The main outcome measure was perceived level of pain intensity. Results showed that both interventions were moderately effective in managing pain and disability in patients with chronic LBP, but that the addition of a SMT seemed to add minimal supplemental benefit to standard treatment.

KEY WORDS: LBP, manipulative, physical therapy, exercise

SAŽETAK

Bol u donjem dio leda (BDDL) može ometati na sposobnost pojedinca za rad, da ima smislen i aktivan društveni život, i negativno utječe na ukupnu kvalitetu života. U posljednjih nekoliko godina, novi pristupi promatraju se kao alternativni tretmani za BDDL. Spinalna manipulativna terapija (SMT) je jedan od tih novih pristupa u akutno liječenje BDDL. Ipak, nedavna studija pokazala kontradiktorne rezultate u smislu učinkovitosti takvih alternativnih terapija. U ovoj studiji cilj je usporediti utjecaj SMT u kombinaciji sa standardne fizioterapije (SFT) u usporedbi samo sa SFT za liječenje kronične BDDL. Uradili smo randomiziranu, kontrolirana usporedba, dvije paralelnih grupa. Ukupno 66 ispitanika su bili upisani u studiju. Intervencije se sastojala od dva uzastopna SMT odvojena dva dana po koje je slijedila SFT za ukupno razdoblje od mjesec dana. Glavni metod mjerenja je bila razina intenziteta boli. Rezultati su pokazali da obje intervencije su umjereno učinkovit u upravljanju boli i invalidnosti u bolesnika s kroničnom BDDL, ali dodatkom na SMT se činilo da daje minimalnu prednost na standardno liječenje.

Nastavi čitati Reduction of pain in patients with lumbar syndrome