Assessment of Changes in the Hemoglobin Level under the Influence of Comprehensive Spa Therapy Using Therapeutic Radon-Sulfur Waters and Its Correlation with Free Radical Reactions.

INTRODUCTION: Hemoglobin is a protein present in erythrocytes of higher organisms. Its main function is to transport oxygen from the lungs to tissues and carbon dioxide from tissues to the lungs. Hemoglobin contains Fe2+, catalyzes free radical reactions, and may initiate oxidation reactions by enzymatic and nonenzymatic degradation. The aim of the study was to evaluate the effect of balneophysiotherapy on the hemoglobin level in osteoarthritis patients and to try to assess the association of those metabolic changes with free radical reactions. MATERIALS AND METHODS: The study was conducted in Przerzeczyn-Zdrój spa resort. It included patients receiving spa treatment over 21-day sessions. The studied group consisted of n = 122 patients with joint and back pain due to osteoarthritis or disc herniation. Their age ranged between 32 and 67 years with a mean age of 53.5. Blood samples were collected before treatment and after 21 days at the spa. Standard tests were used. The results were statistically analyzed using the sign test and the Wilcoxon test. RESULTS: In the study group, we observed a drop in the hemoglobin level following spa treatment. Before treatment, the mean hemoglobin level was 14.1549 g%, and after treatment, it was 14.0008 g%. CONCLUSIONS: (1) In the study, we concluded that balneophysiotherapy in osteoarthritis patients resulted in a decrease in the mean hemoglobin level. (2) The decrease in the mean hemoglobin level in osteoarthritis patients treated at the spa resort may indicate an association with free radical reactions. This trial was registered with NCT03405350.

Assessment of the Level of Pain Intensity and the Level of Anxiety Treated as State and Trait in Patients with Osteoarthritis of the Limbs.

Introduction: Osteoarthritis of the musculoskeletal system is accompanied with chronic pain which is the main factor in mood lowering, causing anxiety. Rehabilitation conducted in the framework of spa therapy and outpatient care aims at eliminating or reducing pain and improving physical fitness. Pain relief is an expected phenomenon because it improves the quality of life. Aim of the study. The aim of the study was to evaluate the effect of rehabilitation in the spa and in outpatient clinic on the level of pain and anxiety in patients with degenerative joints and disc disease. Material and methods. The study included a comprehensive treatment conducted in the spa and in outpatient clinic. Observation included 120 persons with disorders of the musculoskeletal system treated in the spa Przerzeczyn-Zdrój. The second group of patients was treated in the rehabilitation clinic. The examinations were performed before and after treatment. The scope of the observations included self-evaluation of anxiety treated as a state and a trait, the level of intensity of pain, medical history, and sociodemographic background interview. In the observations, there were VAS scale and State Trait Anxiety Inventory STAI used. Result: As a result of the spa therapy and therapy performed in an outpatient clinic, there was an improvement in lowering the level of pain and anxiety noted. Conclusions: 1. Spa therapy and treatment performed in an outpatient clinic reduce the level of pain and anxiety in patients with degenerative disease of the musculoskeletal system. 2. It was found that the therapy conducted in the spa was more effective in lowering the level of pain and anxiety. This trial is registered with NCT03405350.

Assessment of Changes in Concentration of Total Antioxidant Status, Acute-Phase Protein, and Prolactin in Patients with Osteoarthritis Subjected to a Complex Spa Treatment with Radon Water: Preliminary Results.

Spa treatment brings many clinical benefits such as improved physical activity, pain relief, and improved quality of life. In the literature, there are only few objective studies evaluating changes in metabolism possibly influencing clinical outcomes. The main purpose of our study was the assessment of the effect of spa treatment on changes in concentration of TAS, CRP, and PRL in patients with osteoarthritis. Patients receiving spa treatment were enrolled. TAS, CRP, and PRL levels were obtained using standard tests before the beginning of treatment as well as on days 5 and 18. The study group consisted of n = 35 patients with peripheral joint and spinal osteoarthritis. The control group consisted of 15 people selected from the resort staff, who also suffered from osteoarthritis and had no contact with radon. An increase in TAS concentration was found in the study group following therapy while the control group was characterized by a significant decrease in TAS. On day 5, an increase in TAS concentration was found in both groups, however, with much worse result in the control group. No changes in CRP concentration were statistically significant. PRL concentration was proven to decrease in a statistically significant way after treatment in the study group. This trial is registered with NCT03274128.

The Impact of Health Resort Treatment on the Nonenzymatic Endogenous Antioxidant System.

Introduction. Oxygen, reacting with organic compounds in living organisms, oxidizes them without being completely reduced due to numerous exogenous as well as endogenous factors. As a consequence, free radicals or reactive oxygen species are formed. Health resort-based balneophysiotherapy is a comprehensive therapeutic intervention that triggers positive therapeutic effects within the entire system. Material and Methods. The objective of the study was to assess the impact of health resort-based balneophysiotherapy on the levels of nonenzymatic endogenous antioxidants in patients with degenerative motor organ diseases, as well as to determine potential correlation of these changes with free radical-mediated processes. Observation was carried out in patients undergoing health resort therapy as part of 21-day stay periods. The study population consisted of n = 110 patients with articular and spinal pains due to degenerative diseases or discopathies. RESULTS: Reduced bilirubin and albumin levels as well as increased uric acid levels were observed in the study group following the health resort treatment. CONCLUSIONS: Bilirubin and albumin levels were reduced while uric acid levels were increased as the result of health resort therapy in patients with degenerative motor organ diseases. The observed changes in the levels of nonenzymatic endogenous antioxidants depend on free radical-mediated systemic transformations. The trial is registered with NCT03405350.

Assessment of Changes in Lipids Metabolism in Patients with Degenerative Joints and Discs Diseases Subjected to Spa Therapy.

INTRODUCTION: High levels of total cholesterol, triglycerides, and, connected with them, lipoprotein fractions may result in atherosclerosis. There are various forms of therapy used to prevent cardiovascular diseases, such as balneophysiotherapy, the effectiveness of which is confirmed by numerous scientific publications. OBJECTIVE: The objective of this study was to assess the impact of balneophysiotherapeutic procedures on the systemic metabolism of lipids in patients suffering from osteoarthritis of the motor organ. MATERIAL AND METHODS: The study was conducted in the Health Resort Swieradów-Zdrój. Observation included patients undergoing radon water therapy. Before therapy and after 21 days of treatment, lipid profile was assessed with the use of standard colorimetric assay. Study group consisted of n=34 patients with degenerative joints and disc disease. The mean age of patients was 56.5l. The control group consisted of 17 people selected among the employees of the spa also suffering from osteoarthritis. The mean age was 54.2 years. RESULTS: The results of the study are based on a single, 21-day health resort stay period in April/May. A statistically significant increase in HDL cholesterol levels was observed in female patients having undergone health resort treatment (P<0.01). Statistically significant drops in LDL cholesterol and TG levels were observed in the control group (P<0.01). An increase in HDL levels was observed in the male and female control subjects, with P<0.05. CONCLUSIONS: (1) After the end of therapy, there were no changes in lipid metabolism in men, while in the group of women an increase in HDL level was observed. (2) In the control group, statistically significant changes in the field of lipid metabolism may be related to lifestyle changes as a result of educational activities conducted prior to the research. (3) Due to the divergent results, it is advisable to conduct randomized studies in a larger population. This trial is registered with NCT03274128.

The assessment of the integrated antioxidant system of the body and the phenomenon of spa reaction in the course of radon therapy: A pilot study.

BACKGROUND: Spa reaction is an adaptive response of an organism, emerging as a result of external factors. It is a positive element of spa therapy leading to metabolic changes, which are important for the body. The effect of these changes is an increase in immune activity and regenerative reactions of the body. The mechanism of the response is not fully known. OBJECTIVES: The aim of the study was to evaluate the changes observed in the field of the integrated antioxidant system of the body in the course of radon therapy, especially in reference to spa reaction. MATERIAL AND METHODS: The study was conducted in the health resort in Swieradów-Zdrój. The observation regarded patients undergoing treatment with radon water. Before the treatment, after 5 and 18 days of treatment, the total antioxidant status (TAS) was evaluated with the use of a standard colorimetric assay. The study group consisted of 35 patients with degenerative joints and disc disease. The control group consisted of 15 people selected from the employees of the spa, also suffering from osteoarthritis, who did not undergo radon therapy (without contact with radon). RESULTS: On the 5th day of the treatment, in both groups, the TAS increase was observed with significantly worse results in the control group. After the treatment, in the study group, there was observed an increase in TAS, whereas in the control group, a significant decrease in the TAS concentration was noted. CONCLUSIONS: A beneficial effect of radon treatments on the growth of TAS in the body of the patients treated in the spa was demonstrated. The increase in the TAS concentration on the 5th day of treatment may indicate the relationship between these changes and the phenomenon of spa response. The changes are a result of low doses of ionizing radiation originating from radon dissolved in medicinal water, used in the course of the therapy.

The Assessment of the Integrated Antioxidant System of the Body in the Course of Radon Therapy: A Pilot Study.

INTRODUCTION: The sources of Reactive Oxidative Species (ROS) in the organism are the respiratory processes occurring in cells catalyzed by different enzymes. Operation of ROS is balanced by antioxidants, the compounds; although present in low concentrations, they significantly inhibit the degree of oxidation of particular molecules. THE AIM OF THE STUDY: The aim of this study was to assess the changes in the integrated antioxidant system under the influence of radon therapy in osteoarthritis patients. MATERIAL AND METHODS: Observation included 35 patients suffering from degenerative joints and disc disease (mean age 56.5 years) undergoing radon water therapy and control group that consisted of 15 osteoarthritis patients (mean age 54.2) without contact with radon water. Before therapy and after 18 days of treatment, serum total antioxidant status (TAS) was assessed with the use of standard colorimetric assay. RESULTS: In the study group, we observed trends to increase TAS concentration, whereas, in the control group, TAS concentration was decreasing. CONCLUSIONS: (1) Radon waters treatment influenced the level of TAS of osteoarthritis patients treated with the radon water. (2) The change in TAS concentrations in the study group may be the result of low doses of ionizing radiation, but further studies on larger patient's groups are demanded. This study is registered with number NCT03274128.

Surgical Strategy in Intra-pelvic Cup Migration During Total Hip Arthroplasty. A Case Study.

We report the case of a 63-year-old female patient referred to our department due to an early postoperative complication resulting from intraoperative fault. During the preparation of a bone socket for the acetabular cup, the acetabular fossa was broken, forming an extensive segmental defect of the diameter of the reamer used. An attempt to stabilize the acetabular prosthesis using bone cement without repairing the bone defect was ineffective and inappropriate. During the deposition of the acetabular prosthesis on the cement, much of the cement was pushed beyond the outline of the bony acetabulum. Progressive early migration of the acetabular cup together with the cement due to the non-implementation of rapid intervention led to their displacement into the abdominal cavity. On analysing a radiograph performed 3 months after the operation, we decided to adopt a two-stage surgical strategy. In the first stage, the acetabular prosthesis with the cement was removed from a retroperitoneal approach. Three weeks later a revision arthroplasty of the acetabular component was carried out with reconstruction of the acetabular floor.

[Significance of biomechanical criteria in proper treatment planning in knee osteoarthritis].

Introduction: Following the established and unequivocal criteria when choosing the treatment of knee osteoarthritis, despite possibility of precise imaging, is still very problematic. This is partly because doctors of different disciplines: general practitioners, orthopaedic surgeons, rheumatologists, physiotherapists, are involved in the treatment of this disease. For most of them the basic criteria to implement the treatment are: pain and assessment of X -ray in the supine position. As a result of that, despite slight and doubtful improvement, treatment is improperly targeted and extended. The aim of the study was to prove that the correct diagnosis, including biomechanical characteristics of the affected limb, choice of correct treatment, and observance of indications, can shorten treatment, make it more efficient and less expensive. Material and methods: We analyzed of 103 patients qualified for total knee arthroplasty between 2006 and 2011. The indication was primary and advanced knee osteoarthritis in phases III and IV according to Ahlbäcka scale medial displacement of mechanical axis deviation in the lower limb with club- -foot (I to IV degrees) and with centre of rotation of angulation (CORA) in the proximal part of the tibia. Only subjects with body mass index under 25 were included in the study. Surveys were used to assess the pre -operative duration of illness, non-surgical methods of treatment and their effects. Final evaluation was made using the Visual Analogue Scale (10 -degrees) of pain (during the effort and rest) and gait efficiency 30 days after completed treatment. Results: The 66.5% of patients showed no significant improvement in all assessed parameters, which would justify to continuation of the therapy as described above.

[The impact of the spa therapy on reduction of the perception of pain intensity in patients with degenerative joints and disc disease]. / Wplyw terapii uzdrowiskowej na obnizenia natezenia odczuwania bólu u pacjentów z choroba zwyrodnieniowa stawów i kregoslupa.

INTRODUCTION: Degenerative joints and disc disease is accompanied by chronic pain which is the main symptom of the disease. Medical spa therapy has the task of providing comprehensive treatment embracing diseases of limbs as well as other systems and the essential role of medical treatment, in particular spa therapy, is pain relief. The aim of the study was to evaluate the effect of the spa treatment on the level of pain perception in patients with degenerative joints and disc disease. MATERIAL AND METHODS: The observation embraced 120 people with degenerative joints and disc disease treated in the spa. The study included a comprehensive therapy conducted over a 21-day stays at the spa Przerzeczyn-Zdrój with the application of selected physical treatments, physiotherapy and the use of therapeutic natural resources: peloid mud and healing radon-sulphide water. Moreover, there was psychological counseling and health education conducted. The study also included observation of 21 persons from the control group. However, the patients in the control group did not benefit from balneotherapy, psychological care and education. There was a standard VAS scale for pain and non-standard questionnaire of pain assessment constructed for the study purposes. The assessment of pain using the VAS scale and questionnaire of pain assessment both in the study group and the control group were performed before and after the treatment. The results were analyzed statistically, there was Statistica program in Polish version used. In the analysis of the obtained results there were two tests scheduled: the sign test, the Wilcoxon test and descriptive statistics. RESULTS: As a result of the spa therapy and treatments administered on an outpatient basis there was reduction of pain intensity observed. CONCLUSIONS: 1. Spa therapy and outpatient treatment reduce the level of pain in patients with degenerative joints and disc disease. 2. The reduction of pain level was more effective in case of therapy conducted in the spa.

[The achievements of Therapeutic Institute of Eugenia Lewicka in Druskininkai]. / Osiagniecia Zakladu Leczniczego Eugenii Lewickiej w Druskiennikach.

The professional activity of Eugenia Lewicka (1896-1931), a Varsovian doctor, his thorough medical education in various European countries are presented first of all. Her significance for development of Main Institute of Physical Education in Warsaw is mentioned. She was a head of "Helio-, aero-, and kinesiotherapeutical infirmary" in Druskininkai. The achievements this well-known infirmary for development of Polish health resorts are recounted.

Analysis of the influence of a metha-type metaphysical stem on biomechanical parameters.

The full postoperative loading of the limb is possible if patients are properly selected and qualified for hip arthroplasty and the requirements as to the proper position of the metaphysial stem are met. The lack of precision, and patient qualification which does not satisfy the fixed criteria may result in stem setting inconsistent with the assumptions. An analysis based on the finite element method (FEM) will enable one to find out how to plan the magnitude of operated joint loading on the basis of the position of the stem in the postoperative radiograph. By analyzing the distribution of bone tissue deformations one can identify the zones where the spongy bone is overloaded and determine the strain level in comparison with the one determined for a model of the bone with the stem in proper position. On the basis of the results obtained one can estimate the range of loads for the operated limb, which will not result in the loss of the stem's primary stability prior to obtaining secondary stability through osteointegration. Moreover, an analysis of the formation of bone structures around the stem showed that the incorrect setting of a Metha-type stem may lead to the initiation of loosening.

[Clinimetrical scales in spinal cord lesion]. / Skale klinimetryczne stosowane w uszkodzeniu rdzenia kregowego.

Clinimetrics is a specific field of medical science, it is the science of measurement of clinical occurrence in a patient. The aim of clinimetrics is to construct scales to evaluate patients with clinical indicators. The inclusion of the patient's condition in the point value allows to objectified, compare and evaluate treatment and to carry out mathematical and statistical analysis in science researches. A review of clinimetrical methods used in spinal cord lesion was made in reference to both injury and functional scales. The latest tools for functional assessment of patients after spinal cord injury--Spinal Cord Independence Measure (SCIM) and Walking Index for Spinal Cord Injury (WISCI)--were described. Properly selected and used the scales let achieve a goal, which is unambiguous, repeatable and quantitative summary of clinical phenomena.

Professor Ludwik Hirszfeld in his relations with students and junior researchers.

This paper presents a profile of Ludwik Hirszfeld (1874-1954) as an educator of medical personnel. Hirszfeld was an eminent immunologist, bacteriologist and seroanthropologist; the originator of the Polish school of immunology; a professor at Warsaw University, Maria Sklodowska-Curie University in Lublin and the University and Technical University in Wroclaw; and the founder of the Institute of Immunology and Experimental Therapy in Wroclaw. An account of his relations with university students and junior research personnel - relations based on respect, on multi-faceted assistance in everyday life, but above all on a love for science - is presented, depicting Hirszfeld as a teacher of scientific thinking.

The first Polish total laryngectomies.

The total removal of the larynx (total laryngectomy), performed in 1872 by the well-known Viennese surgeon Christian A. Theodor Billroth (1829-1894), was an epoch-making event in the history of surgery and laryngology. This paper presents the first surgeons who performed this operation. The first Pole who performed a total laryngectomy (1877) was Julian Kosinski (1833-1914), head of the Surgical Clinic of Imperial University Warsaw. It was the 14(th) operation of this kind in the world. Several laryngectomies were carried out by Franciszek Ksawery Jawdynski (1851-1896), called the father of Polish head and neck surgery, who was the first Pole to excise a malignant neck cancer together with the lymph nodes. The next total laryngectomies were performed by the following Polish surgeons: Jan Mikulicz-Radecki (1850-1905), Wladyslaw H.S. Krajewski (1855-1907), Alfred Obalinski (1843-1898). According to Jan Sedziak, by 1897 Poland with 16 laryngectomies (per 188 carried out) had occupied the fourth position in the world. The failures of the first laryngectomies were due to such factors as the ignorance of shock pathophysiology, the inability to ensure the patency of the airways during and after the operation, which would result in lung and mediastinum infections, massive haemorrhages and so on. But the primary cause was the lack of constructive collaboration between the laryngologists and the surgeons.

Achievements of Polish doctors in gastrodiaphanoscopy at the turn of the 19(th) and 20(th) centuries.

Diaphanoscopy/transillumination, the method of shining a bright light through tissues, was devised in the mid-19(th) century and developed after the invention of the light bulb by T.A. Edison. Benjamin Milliot was the first to examine the stomach by means of an incandescent platinum wire. The experiments conducted by Max Einhorn using a device consisting of a Nelaton catheter with an inserted light bulb, were valuable. In Poland the method of gastrodiaphanoscopy was popularized by Teodor Heryng, Mikolaj Rejchman and by Warsaw doctors. They used a diaphanoscope consisting of a gutta-percha probe distally equipped with a metal attachment with a light bulb hidden in it and with a so-called cooling device. The examination would usually be conducted in the standing position after the stomach had been filled with water. Light patches corresponding to the stomach's lower and side boundaries would be obtained. Rejchman's observation, that such a contractile and flexible organ as the stomach, changing its volume and position, is bound to change its light image, was correct. Heryng's and Rejchman's research inspired the foreign researchers Renvier, Leopold Kuttner and John Jacobson. Extensive research was subsequently conducted by C.A. Meltzing and Wilhelm Schwartz. Diaphanoscopy would also be performed by Walery Jaworski, the pioneer of gastrology. He was particularly interested in transillumination of the stomach, peritoneum and omentum tumours. Eugeniusz Kozierowski, a practicing physician from Gorlice, diagnosed neoplastic pylorostenosisusing this method. Gastrodiaphanoscopy is a historical method, now of no value against gastroendoscopy and the state-of-the-art methods of image diagnostics.

[The development of treatment in the Birstonas health resort up to 1939 and the physicians of Birstonas in the 19th and first half of the 20th century]. / Rozwój lecznictwa uzdrowiskowego w birsztanach do 1939 roku. birsztanscy lekarze W XIX i pierwszej polowie XX wieku.

First of all, the history and development of Birstonas, a health resort by the river Neman, near Vilnius, first mentioned in 1382, are recounted in detail. The value of this health resort was determined by a mild climate and salt springs. Information on Birstonas by Wladyslaw Syrokomla (1823-1862), the Polish poet, and Zygmunt Gloger (1845-1910), the Polish ethnographer, archaeologist and historian are well known. The indications and contraindications in many diseases, and the effects of treatment in this health resort are described. Finally, the opportunities for recreation and the attractions in this charming health resort are presented. Attention was paid to the leading role of Poles in the development of this health resort now in Lithuania. The biographies of several physicians practicing in Birstonas: Jan Sokolowski, Aleksander T.W. Korewa, Anicety Renier, Stanislaw K. Wikszemski, Benedykt Bilifiski, Erminio Andriolli, Roman Przybylski and Pawel A. Sawicki are presented. Their biographies, professional achievements and work in Birstonas are depicted in detail.

[The development of treatment in a health resort in Niemirow until the end of the second republic]. / Rozwój lecznictwa uzdrowiskowego w niemirowie do konca drugiej rzeczypospolitej polskiej.

The history ofNiemirów, a health resort on the south-eastern borderland of Poland is recounted in full particulars first of all. A mild climate, charming regions, natural stuffs (sulphuric-alkaline salt springs and therapeutic mud) formed the status of this health resort. The indications and contraindications in many diseases and effects of treatment in a health resort are described. The bats in Niemirów and fixtures are presented widely. The chances of recreation and attractions in this health resort are presented finally.

[Anicety Renier (1804-1877) and his significance for development of Druskienkai]. / Anicety Renier (1804-1877) i jego znaczenie dla rozwoju Druskienik.

The aim of his paper is to present the silhouette of Anicety Renier (1804-1877), an eminent physician, patriot, deportee. His professional achievements as a physician of health resort in Druskienkai are presented widely. He was the author of publications on this health resort.

[Jan Pilecki (1821-1878) and achievements his Druskieninkai]. / Jan Pilecki (1821-1878) i jego Druskienickie osiagniecia.

The history of development of health resort Druskieniki basing on Adam Wrzosek, an eminent Polish historian of medicine pointed out. The beauty and advantages of this health resort is depicted widely. The living and professional achievements of Jan Pilecki (1821-1878), an eminent physician of health resort, his significance for development and of Druskieninkai are presented in more detail. The medical indications and contraindications in Druskieniki basing on his own experiences have been reported. Pilecki was a author of many medical publications in Polish medical magazines. His papers contained interested medical observations and description of social life and entertainments in this health resort.