The impact of selected metallic elements in the environment on the occurrence of osteoporosis in the voivodeship of Silesia.

Background. The existence of toxic metallic elements in the environment is one of the most important factors influencing the metabolism of calcium. The aim of our study was to compare the incidence of osteoporosis in Upper Silesia to the level of environmental pollution with lead, cadmium, zinc, and copper. Material and methods. An epidemiological data base gathered by the Silesian Branch of the National Health Fund was used to gather data concerning the incidence and treatment of osteoporosis in Silesia, with and without pathological fractures. Results. The results of our analysis suggest that the frequency of osteoporosis, with or without pathological fractures both, correlates with increased concentrations of lead, cadmium, copper and zinc in the environment. This relation can be noticed especially in the Upper Silesian Industrial District. Conclusions. In regions with increased risk due to the occurrence of significant amounts of heavy, osteotropic elements, programs should be implemented to intensify screening for osteoporosis.

[Cost-effectiveness of coronary angioplasty procedures in Poland]. / Koszt i efektywnosc zabiegów angioplastyki wiencowej.

BACKGROUND: Restenosis following percutaneous coronary interventions (PCI) increases re-hospitalisation rate and may lead to new myocardial infarction (MI) or death. Besides medical aspects, it may also reduce cost-effectiveness of the procedure. AIM: To analyse the medical and economical outcome of patients treated with PCI during a one year period. METHODS: Medical outcome, cost of PCI and total cost of treatment during one year after PCI were assessed in 188 consecutive patients who underwent PCI during the first three months of 2002. Patients with acute MI treated with PCI were not included in the analysis. RESULTS: The rate of major adverse cardiac events (MACE) which included death, new MI or repeated revascularisation, was 1.6% during hospital stay and 14.4% during one-year follow-up. Re-hospitalisation rate was 28.2%. The mean number of outpatient visits during one year was 9.8. The costs of initial hospitalisation and procedures performed during this hospital stay were 7,839 Polish zlotys (PLN) per patient whereas the costs during one-year follow-up were 3,490 PLN (re-hospitalisations and repeated procedures 3,091 PLN, outpatient visits 238 PLN, and pharmacotherapy costs 161 PLN). In the group of patients with MACE, the costs of treatment during one-year follow-up were 13,398 PLN whereas in patients without complications 1,349 PLN per patient. CONCLUSIONS: Patients who develop complications after PCI generate costs exceeding ten times that of patients with a favourable outcome. Thus, from the economical and medical point of view, there is a need to identify high-risk patients before the decision is made as to which type of treatment is used. Because the health service in Poland is under-funded, patients at risk should be treated with the most effective methods (antiproliferative stents or surgical revascularisation) as an initial treatment, which may decrease total costs during a long-term period.

Management of foot deformity in cerebral palsy.

Treatment of patients with cerebral palsy need particular management: diagnostics, early interventions, programme of functional estimations, rehabilitation, therapy with conservative methods (injections of botulin toxin, immobilizing cast) and surgical methods. Correction of foot deformations is only one part of general process of treatment, which target is usually equalization strength between antagonistic muscle groups, what influences on improvement of locomotion, enlargement of range joint mobility, diminution of pain and making possible orthopedic supplies. In 1997-2001 we treated 58 children with foot deformation in cerebral palsy. One talk overed mechanism of deformation and management in dependences from type, degree of deformation, and age of patient.

[The algorithm of physiotherapeutic procedures in patients after total cementless joint arthroplastics]. / Algorytm postepowania fizjoterapeutycznego u pacjentów po totalnej bezcementowej alloplastyce stawu skokowo-goleniowego.

The aim of this study is to present the physiotherapeutic procedure in patients after total cementless ankle atrhroplastics. It was introduced thus far methods and resources in the way of physics and kinesitherapy, how also methods in physical medicine, which there are introduced to numerous department of medicine also in orthopedics. From reason of small number of reports, the authors present in this work current dates of relate in physiotherapeutic procedure before and after cementless ankle arthroplasty, which profitably influence and show the characteristic improvement of local and general state in patient. In spite of existing limitations the introduced plan with patients after total cementless joint arthroplasty should facilitate taking of sure solutions and workings persons with this patients.