PREDICTIVE FACTORS FOR SUCCESSFUL PROSTHETIC REHABILITATION AFTER VASCULAR TRANSTIBIAL AMPUTATION.

Lower extremity amputation is a very common amputation and successful prosthetic rehabilitation is a desirable outcome. The aim of this study was to determine which factors affect the success of prosthetic rehabilitation after transtibial vascular amputation. The study included 61 patients who had undergone transtibial amputation (mean age, 64.2±10.4 years; 50 (82%) males). Patients who were able to walk at least 45 meters without aids or with only one walking stick after rehabilitation program were classified into the group of successful prosthetic users. Age, gender, comorbidities, patency of the popliteal artery, wound healing complications, and presence of the phantom limb pain were used as predictive variables. Multivariate logistic regression analysis was used to identify predictive factors of successful prosthetic rehabilitation. The model included all variables explaining up to 59.8% of variance, however, only age, absence of functional patency of the popliteal artery and compromised wound healing made significant contribution to the model. In conclusion, good general condition of the patient and sustained patency of the popliteal artery reliably led to clinical improvement and realization of full capacity of rehabilitation after below-knee amputation.

Cerebrovacular Reserve Predicts the Cerebral Hyperperfusion Syndrome After Carotid Endarterectomy.

BACKGROUND: Cerebral hyperperfusion syndrome is a rare but potentially severe complication of carotid artery revascularisation that develops under conditions of resistant postoperative hypertension and impaired cerebrovascular autoregulation. OBJECTIVE: Was to determine which preoperative and operative factors affect the development of cerebral hyperperfusion syndrome after carotid endarterectomy. METHODS: This prospective observational study enrolled 93 asymptomatic patients who underwent carotid endarterectomy. Cerebral hyperperfusion was registered in patients who had 100% postoperative increase in mean flow in middle cerebral artery registered by Transcranial Doppler ultrasound. Cerebral hyperperfusion syndrome was diagnosed in patients with cerebral hyperperfusion who postoperatively developed at least one of the symptoms. Pre-operative and operative risk factors for cerebral hyperperfusion syndrome were analysed by multivariate binary logistic regression. RESULTS: Out of 93 operated patients, cerebral hyperperfusion was registered in 23 and cerebral hyperperfusion syndrome in 18 patients. Risk factors for cerebral hyperperfusion syndrome were included in the binary logistic regression model. Incomplete Circle of Willis morphology on 3D TOF magnetic resonance image (p = 0.002), Breath holding index below the 0.69 cut-off (p = 0.006), positive criteria for insufficient collateral flow through circle of Willis registered by TCD (p = 0.03), and poorly controlled hypertension (p = 0.023) showed statistically significant independent predictive value for cerebral hyperperfusion syndrome. The model was statistically significant (p = 0.012) and correctly classified 90.3 % of patients. CONCLUSIONS: Incomplete circle of Willis and insufficient collateral flow, low cerebrovascular reserve, and poorly regulated hypertension are significant predictors of post- carotid endarterectomy hyperperfusion development.

THE RELATIONSHIP BETWEEN THE RANGE OF MOTON OF THE HIP JOINT WITH RUPTURED ANTERIOR CRUCIATE LIGAMENT.

INTRODUCTION: A knee injury, especially anterior cruciate ligament. has recently become more common significantly affecting the life standard. There are many factors that cause an injury of the anterior eruciate ligament, ~nd one of them is limited range of motion in the hip joint. This studyhas been aimed at finding a relationship between the range of motion in the hip joint and the anterior eriiciate ligament injury. Matcrial and Methods. Of88 male athletes included in the study sample in 2014, 60 (68%) had ruptured knee anterior cruciate ligament and 28 (32%) were without an injury. There was no sianificant difference in sex, height, weight, age and time of injury between the two groups. RESULTS: Significant differences were found in the range ofmotion between the lefi and right leg in both groups. The athletes with a ruptured anterior cruciate ligament had an abduction limit of the hip joint (p0.007) and a wider rang of motion of the knee joint (p0.O02) than thc athletes without the inj Liry. CONCLUSION: Data obtained in this study suggest a possible relationship between a limited hip abduction of range of motion in athletes and an increased risk of anterior cruciate ligament injury.