The operative treatment of pressure sores in the pelvic region: A 10-year period overview.

CONTEXT: Pelvic region pressure sores often develop following spinal cord injury. Surgery is often necessary for long standing, large-sized pressure sores not responding to conservative treatment. Authors analyze their results of a 10-year period, and identify factors contributing to the reduction of the recurrence rate. METHODS: A total of 119 pressure sores were operated on 98 patients in two institutions during a 10-year period (1 January 2003 to 31 December 2012). The encountered perioperative complications are summarized, and the recurrence rate is analyzed with a patient follow-up questionnaire. RESULTS: We experienced 15 perioperative complications (12.6%). All complications were fully resolved by conservative treatment. Fifty-eight returned patient replies were processed. The average follow-up time after surgery was 5.2 years. The recurrence rate was 5.47%. CONCLUSION: The strict adherence to surgical indications, full patient compliance, specialized pre- and post-operative patient care, our routinely used preferred surgical method, all contribute to a low post-operative complication rate, long-term flap survival, and an extended recurrence free period.

[Results of intrathecal baclofen therapy on spasticity in patients with brain injury]. / Az intrathecalis baclofenkezelés tapasztalatai agykárosodást szenvedett, spasticus felnott betegek esetében.

OBJECTIVES: To evaluate the results of intrathecal baclofen (ITB) therapy on the spasticity in patients with brain injury. METHOD: Retrospective study in Brain Injury Rehabilitation Unit between January 2001 and December 2010. RESULTS: During the last ten years, in our unit 13 patients were involved into ITB therapy on severe spasticity, after brain injury, while more than 100 Baclofen pumps were implantated in Hungary with coordination of the Multidisciplinary Team. ITB therapy was indicated in severe spasticity that developed in seven cases of traumatic brain injuries, five cases of strokes and one case of anoxic brain injury. The mean age of patients was 26 years (18-52). At the time of pump implantation three patients were in vegetative state. The shortest period elapsed between the brain injury and pump implantation was three months and the longest period was nine years, mean 15 months. Baclofen pump had to be changed in six cases after six years, and was removed in three cases due to decreasing spasticity. Catheter revision was performed in two cases due to flow problem. We had no complication in association with ITB therapy. CONCLUSIONS: Intrathecal baclofen therapy seems to be an effective and safe treatment in patients with severe spasticity of cerebral origin. We suggest team (neurosurgeon and rehabilitation professionals) decision in a spasticity center before involving the patient into ITB therapy, and follow up in the rehabilitation unit. The severity of spasticity as a consequence of brain injury can change during years and it is necessery to follow it with dosage and dynamics of baclofen therapy. Baclofen pump removal is suggested if the ITB therapy is further not reasonable.

Improving functional electrical stimulation driven cycling by proper synchronization of the muscles.

Our aim is to define optimal stimulation patterns for controlling lower limb movements of spinal cord injured patients. Here we report on a study about cycling movements of healthy subjects under regular conditions and spinal cord injured patients whose cycling movement was generated by functional electrical stimulation. The stimulation pattern required for coordinated activities of lower limb muscles of spinal cord injured patients was improved by using the observations what we gained from measuring and analyzing cycling movements of 42 young healthy subjects. Kinematical parameters (joint angles) and muscle activities (EMG) were recorded simultaneously by an ultrasound based movement analyzing system. We replaced the cycling program of the commercially available stimulator with a new one that we developed on the basis of the measured healthy cycling movements. We present that our new stimulation patterns provided a great increase in the performance of our spinal cord injured patients.

[Statistics of urinary incontinence of women in Hungary]. / A noi vizeletinkontinencia országos statisztikai vizsgálata.

INTRODUCTION: According to recent national and international experience the number of people suffering from urinary incontinence is increasing. OBJECTIVE: To gain solid data on the incidence and origin of the condition, age and medical history of the affected patients in an epidemiological study. METHODS: The authors directed a national statistical survey regarding female incontinence. 35,448 women's data were collected about the predisposing factors. RESULTS: 36% of the women asked considered themselves incontinent. The authors analyzed the connection between the condition and factors such as the number and type of deliveries, and the weight of the babies. CONCLUSIONS: After the extrapolation of the data the number of incontinent women in Hungary should be near 600,000, which contradicts previous calculations. This makes female urinary incontinence a national health problem, which should be subject to further sociological and medical studies.

[Surgical treatment of decubitus ulcers of the pelvic area in patients with spinal cord injury]. / A medencetájéki decubitusok mütéti kezelése gerincvelösérült betegeknél.

Pressure sores in spinal cord-injured patients can be treated by either conservative or surgical methods. Shortened healing period and long lasting results can be achieved by surgery. Between 1993 and 2001 the authors performed 64 operations with musculocutaneous or musculo-fasciocutaneous flaps in all cases. All patients healed primary except one, whose 20-year-old pressure sore transformed malignant and gave metastasis. The complication rate was 21.42%, that equals with the data of the literature. Measuring the late postoperative results by follow-up questionnaire, a 9.52% ratio of recurrence was found, which was significantly smaller than data of the literature (19-82%). Authors analyse the causes of their (good) results.