The benefits of ventriculoperitoneal shunting in normal pressure hydrocephalus patients-a follow-up of three years.

OBJECTIVE: The ventriculoperitoneal shunt (VPS) is an established approach in treating normal pressure hydrocephalus (NPH). This study aims to examine the long-term effects of VPS regarding clinical and radiological outcomes, to explore interdependencies with comorbidities and medication, and to determine a suitable opening pressure of the programmable valve. METHODS: 127 patients with VPS were retrospectively evaluated. The Hakim triad along with Evans index (EI) and callosal angle (CA) were examined preoperatively and postoperatively at various time points up to over thirty-six months. Preexisting comorbidities and medication were considered. Adjustments to valve settings were documented along with symptom development and complications. Wilcoxon and paired-sample t-tests were used to analyze postoperative change. Chi-square, Eta-squared, and Pearson coefficients were used in correlation analyses. RESULTS: Relief from individual symptoms was most prominent within the first 6 months (p < 0.01). EI and CA significantly decreased and increased, respectively (p < 0.05). Postoperative clinical and radiological improvement was largely maintained over the follow-up period. Diabetes mellitus and apoplexy correlated with surgical outcomes (p < 0.05). The median opening pressure as a function of overall symptom management was determined to be 120 mmH2O for women and 140 mmH2O for men. CONCLUSION: VPS is effective in treating NPH with respect to both clinical and radiological outcomes, although these two components are independent of each other. Improvement is most pronounced in short-term and maintained in the long-term. Comorbidities have significant influence on the course of NPH. The valve setting does not forecast change in radiological findings; consequently, priority should be placed on the patient's clinical condition.

Human Exposure to Heavy Metals over the Last 100 Years.

The primary objective of the presented research was to assess the impact of intense global economic development, over the last 100 years, on the bioaccumulation of heavy metals in the human body. This evaluation was conducted based on the measurement of heavy metals in human hair samples collected 100 years ago in present-day southern Poland.In this study, concentrations of lead (Pb), cadmium (Cd), arsenic (As), zinc (Zn), copper (Cu), iron (Fe), and selenium (Se) were measured in 61 hair samples,28 of which were obtained from individuals who lived 100 years ago, while the remaining 33 constituted the contemporary control group. The concentrations were determined using a triple quadrupole inductively coupled plasma mass spectrometer (Agilent 8900). Statistical analysis of the obtained results was conducted using the Principal Cmponent Analysis and the non-parametric Mann-Whitney test. In the case of As, Pb, Cd, and Fe, the concentrations were significantly higher in individuals who lived 100 years ago compared to those living today. Over this period, the median concentrations were shown to have decreased by 95%, 94%, 85%, and 69% for As, Pb, Cd, and Fe, respectively. No statistically significant differences were observed for Cu, Zn, and Se. The results obtained for Pb, Cd, As, and Fe unequivocally indicate that the population studied from 100 years ago was more exposed to internal contamination with these metals than people who live nowadays.

The level of actual functional fitness of men from different living environments in Poland and associations with health - a cross-sectional study.

BACKGROUND: The study aimed to assess the differences in functional fitness between older men living in social welfare homes (SWH) and men living in society. METHODS: The study involved 474 men aged 60-84, including 134 men living in social welfare homes and 340 men living in community. The Senior Fitness Test was used to assess functional fitness. Body weight and height were measured. Moreover, data on age, education, taking up physical activity and place of residence were collected. RESULTS: A significantly lower level of functional fitness of SWH residents was demonstrated compared to men living in the society (p < 0.001). A significant percentage of seniors living in SWH did not reach the normal range for the Polish population. Also, the level of education, physical activity and health self-assessment differentiated the institutionalized men from those living in the community. CONCLUSIONS: The place of residence is a factor that differentiates seniors' functional fitness levels. The reduced fitness of social welfare home residents may also result from the low level of their daily physical activity, education and health. Introducing physical activity programs for elderly residents in social welfare homes seems reasonable. TRIAL REGISTRATION: ISRCTN platform as 18,225,729; December 2020.

Technical and Tactical Actions of the World's Leading Male Table Tennis Players Between 1970 and 2021.

This research aimed to determine the quantitative and qualitative structure of winning systems of the world's leading male table tennis players between 1970 and 2021. The study used the Wu game analysis method, modified by the authors, which consists of observing the game from playback, identifying the winning actions of a given player, and sorting and counting the actions, depending on the accuracy of the observation. The project identified all World Championships and Olympic Games medallists, resulting in 244 men's matches being analyzed. Three time periods were considered based on the ball used, including the 38 mm celluloid ball, 40 mm celluloid ball, and 40 mm plastic ball. Differences in the level structure, depending on the observation period, were assessed using the chi-squared test of independence. The Pearson contingency coefficient was calculated, and multiple comparisons were made. The research showed that the use of combinations changed slightly with changes in ball size and material. The first three strokes were very important in all periods. However, the importance of serves as direct scoring strokes decreased. These findings may be related to changes in the size and material used for ball production. The most winning serves in the game of the top men were side-spin forehand serves, which were also used most often during 3rd-ball-attack winning combinations. The number of actions won directly with a return, and in the return-counterattack combination, accounted for, and still constitute, about 30%, with an increasing number of backhand flicks. The research also showed an increase in the use of backhand strokes compared to forehand strokes. These findings should be considered when creating basic goals in table tennis training plans.

Tumor treating fields therapy is feasible and safe in a 3-year-old patient with diffuse midline glioma H3K27M - a case report.

Since high grade gliomas are aggressive brain tumors, intensive search for new treatment options is ongoing. For adult patients with newly diagnosed (ndGBM) and recurrent glioblastoma (rGBM), low intensity intermediate frequency alternating electric fields, known as tumor treating fields (TTFields) have been established as a new treatment modality. Tumor treating fields significantly increase survival rates in combination with adjuvant temozolomide (TMZ) in adult and GBM patients. Here, we report about feasibility and safety of treatment on a pediatric patient with diffuse midline glioma who is receiving TTFields therapy in combination with temozolomide.

Appendicular skeletal muscle mass and quality estimated by bioelectrical impedance analysis in the assessment of frailty syndrome risk in older individuals.

BACKGROUND AND AIM: The rising aging index of many populations necessitates the continuous evolution of geriatric assessment methods, especially the ones used to identify frailty and the risk of frailty. An appropriately early diagnosis of adverse changes in skeletal muscles can reduce the risk of functional limitations in elderly persons. The aim of this study was to assess the correlation between the appendicular skeletal muscle mass and quality, estimated by the bioelectrical impedance analysis method, and the risk of prevalence of the pre-frailty state in elderly persons. METHODS: One-thousand-and-fifteen subjectively healthy persons aged 60-87 years were tested. Anthropometric measurements and physical fitness and activity measurements were carried out and the frailty phenotype was evaluated. Appendicular skeletal muscle mass was estimated using the bioelectrical impedance analysis method. Muscle quality was assessed through an index correcting strength relative to muscle mass and through the impedance phase angle. The correlation between the muscle mass and quality estimating parameters and the probability of identifying pre-frailty was checked using multiple logistic regression. RESULTS: The prevalence of pre-frailty was 38%. The pre-frail persons were found to have a significantly lower muscle mass and quality than the non-frail persons, with the difference in the case of the muscle quality index nearly twice larger than for the muscle mass index. A significant logit model was obtained for pre-frailty prevalence, which was strongly dependent on the appendicular skeletal muscle mass (adjusted odds ratio (OR): 0.43, 95% CI 0.36-0.52, p < 0.001) and functional quality (adjusted OR: 0.26, 95% CI 0.18-0.38, p < 0.001) and less on age (adjusted OR: 1.10, 95% CI 1.07-1.13, p < 0.001). CONCLUSION: The strong correlation between the frailty phenotype and appendicular skeletal muscle mass and functional quality suggests that the two variables should be included in routine geriatric assessment with regard to frailty.

The Predictive Value of Transcutaneous Electrical Nerve Stimulation for Patient Selection in Peripheral Nerve Field Stimulation for Chronic Low Back Pain: A Prospective Study.

OBJECTIVE: Peripheral nerve field stimulation (PNFS) is an effective alternative treatment for patients with chronic low back pain. Transcutaneous electrical nerve stimulation (TENS) is frequently used in pain therapy. Aim of this prospective study was to examine the predictive value of TENS for later PNFS treatment. MATERIALS AND METHODS: Between 2014 and 2019, a prospective cohort study of 41 patients with chronic lumbar pain was conducted. Pain intensity (NRS) was assessed before and after TENS use, preoperatively/postoperatively and in the follow-up after three and six months, SF12v2 questionnaires with physical (PCS) and mental component summary (MCS) scores, and Oswestry disability index (ODI) questionnaire at baseline as well as three and six months after PNFS implantation. Implantation of the PNFS-system with two percutaneous leads was performed after four to seven days of positive testing. Statistical analysis was performed using depending t-test, ANOVA, and Spearman correlation. RESULTS: The cohort consisted of 41 patients (19 females, 22 males) with a median age of 60.5 years (IQR25-75 52-67). Two patients were lost to follow-up. After positive PNFS testing a pulse generator (IPG) was implanted in 15 patients with positive TENS effect and 15 patients without TENS effect. Leads were explanted in nine patients after negative PNFS trial phase. TENS positive patients showed significant correlation to a positive effect in the PNFS trial phase in NRS reduction (p = 0.042) indicating that TENS responders will also respond to PNFS (94% patients). After three and six months follow-up median NRS and SF12v2 (PCS) improved significantly in both cohorts, SF12v2 (MCS) and ODI only in the TENS positive cohort, respectively. CONCLUSION: TENS can be predictive for patient selection in PNFS, as TENS positive patients showed significant correlation with a positive PNFS trial period. Therefore, TENS positive patients might be justifiable to be directly implanted with leads and IPG. TENS positive patients further tend to show a better improvement in the follow-up.

Preoperative Elevated Levels for Depression, Anxiety, and Subjective Mental Stress Have No Influence on Outcome Measures of Peripheral Nerve Field Stimulation for Chronic Low Back Pain-A Prospective Study.

OBJECTIVE: Peripheral nerve field stimulation (PNFS) is an effective alternative treatment for patients with chronic low back pain. The treatment of low back pain strongly depends on psychological factors like anxiety, depression, and mental stress. The aim of this study was to evaluate the impact of such factors on outcome measures after lead- and implantable pulse generator-implantation. MATERIALS AND METHODS: Between 2014 and 2019, a prospective cohort study of 39 patients with chronic lumbar pain was conducted. Hospital Anxiety and Depression Scale (HADS) score was assessed at baseline to measure symptoms of anxiety and depression. Symptom checklist-90 (SCL-90) was used to measure subjective psychopathology. Pain intensity (numeric pain rating scale [NRS]), SF12v2 with Physical Component Summary and Mental Component Summary (MCS) scores, and Oswestry Disability Index (ODI) were assessed pre- and postoperatively as well as three and six months after PNFS implantation. Outcome values were compared to baseline data. Statistical analysis was performed using depending t-test and analysis of variance (ANOVA). A p value <0.05 was considered significant. RESULTS: The cohort consisted of 39 patients (18 females, 21 males) with a median age of 61 years (IQR25-75  = 52-67 years). NRS, ODI, and SF12v2 showed significant improvement in the whole follow-up period compared to baseline values (p < 0.05). Elevated HADS scores for anxiety were seen in 64.1%, for depression in 76.9% of the patients at baseline. SCL-90 was pathologic in 71.8% of the cases. A one-way ANOVA revealed no differences between elevated HADS- and SCL-90 values and all outcome measures after PNFS implantation in the whole follow-up period (p > 0.05). CONCLUSION: Chronic low back pain is often associated with psychological distress. Our study showed highly elevated levels for anxiety and depression as well as subjective mental stress in patients with chronic low back pain without negative impact on NRS, ODI, and SF12v2 in the whole follow-up after PNFS implantation.

Multicenter Experience with Nusinersen Application via an Intrathecal Port and Catheter System in Spinal Muscular Atrophy.

Nusinersen, an antisense oligonucleotide enhancing the production of the survival motor neuron protein, is approved for the treatment of spinal muscular atrophy (SMA) but requires repetitive lumbar punctures. Application via a subcutaneous port connected to a permanent intrathecal catheter has been proposed as an alternative for patients with severe scoliosis, spinal fusion, or comorbidities, rendering serial interlaminar punctures complicated and risky. Since experience with this technique is sparse and follow-up data are lacking, we assessed feasibility, safety, and tolerability of this approach in eight patients with SMA II/SMA III receiving Nusinersen in a multicenter study. Median age at port implantation was 21 years (range: 10-30 years), and median follow-up time thereafter was 19 months (range: 7-24 months). Leakage of the port catheter occurred in two patients, promptly resolving after resuturing. No further complications such as infection, dislocation, kinking, or obstruction of the port were noted in any of the patients. These findings suggest that application via an intrathecal port and catheter system represents a safe and feasible option for Nusinersen treatment in subjects with SMA. However, to detect rare adverse events longer term follow-up in a larger study cohort is warranted.

Programmable valve breakage in shunt systems of children with posthemorrhagic hydrocephalus after minor head trauma-a case series.

PURPOSE: We report five rare cases of programmable valve breakage (Codman Hakim-Medos valve) in shunt systems of children with posthemorrhagic hydrocephalus. Only four similar studies have been published in the current literature. METHODS: Between 2013 and 2018, five children with posthemorrhagic hydrocephalus were admitted to the pediatric department. All patients had a history of slight blows to the head in a minor trauma and follow up MRI scans. After initial clinical examination, cranial computed tomography (CT) and X-ray were conducted. RESULTS: In all cases, pumping the reservoir resulted in very slow refilling. The cranial CT in one patient showed slit ventricles confirming the suspicion of overdrainage, the other cases a slight enhancement of the hydrocephalus. In lateral X-rays of the skull in comparison to the first X-ray control of the shunt valve, the pressure control chamber could be seen dislocated in the inferior part of the reservoir in all cases. Surgery revealed that the shunt valve was broken. The pressure control chamber had dropped to the bottom of the reservoir. After implantation of a new shunt valve, the symptoms resolved completely in all five children. Overall this complication occurred in 4.3% (5 of 85 implanted Codman Hakim-Medos valve) of all children necessitating ventriculoperitoneal shunt implantation between January 2013 and December 2018. CONCLUSION: The well-accepted Codman Hakim-Medos programmable valve is part of a tube-system, which is designed to offer the possibility of a reliable and precise treatment of hydrocephalus. Various mechanical and non-mechanical complications of shunt systems have been reported. Valve breakage is a very rare condition, often missed, and must be kept in mind when trauma and prior MRI scan are reported.

Changes in the bioelectrical impedance parameters estimating appendicular skeletal muscle mass in healthy older persons.

BACKGROUND AND AIMS: As population ageing, it is necessary to use inexpensive and widely available methods of monitoring healthy ageing to earlier detect the risk of potential ageing-related diseases. As an alternative to the reference methods, bioelectrical impedance analysis (BIA) enables one to quickly and easily estimate appendicular skeletal muscle mass, which in the case of older persons is an indicator of their physical fitness. The aim of this study was to evaluate the actual bio-impedance parameters used to estimate body composition, as possible markers of changes in the mass of the appendicular skeletal muscles in the course of ageing. METHODS: Four hundred and thirty-five persons (including 107 men and 328 women) aged 50-87 years (65.6 ± 6.4 years) participated in the study. Anthropometric measurements and measurements of the bioelectrical impedance components (resistance, reactance, and phase angle) were carried out. Using the prediction equations, appendicular muscle mass and appendicular skeletal muscle mass were estimated. RESULTS: Differences in the bio-impedance parameters between older persons aged 65 + and persons on average 10 years younger have been demonstrated and the impedance components have been shown to be correlated with age, the correlations being stronger in the persons after the 65th year of life. CONCLUSIONS: The actual bioelectrical impedance parameters measured directly using the BIA method of estimating body composition are good identifiers of the changes in the mass of the appendicular skeletal muscles in older persons in the course of ageing.

Interdisciplinary Laparoscopic Implantation of Neuromodulation Leads to the Sacral Plexus for Therapy of Chronic Pelvic Pain and Neurogenic Bladder Dysfunctions.

OBJECTIVE: The aim of this study was to report on the use of laparoscopic implantation of leads on the branches of the sacral plexus for neuromodulation in the treatment of chronic pelvic pain (CPP) in a multidisciplinary setting with the help of electrophysiological neuromonitoring. MATERIALS AND METHODS: Between 2012 and 2019, six female patients complaining of chronic pain and bladder and bowel dysfunctions underwent laparoscopic exposure and nerve identification with the help of electrophysiological neuromonitoring. A lead was placed laparoscopically in direct contact with the affected nerve. Pain intensity (numerous ranking scale [NRS]), generic health status (EQ-5D-5L), Becks Depressions Inventory (BDI-V), Pain Catastrophizing Scale (PCS), and Client Satisfaction Questionnaire (CSQ-8) were assessed pre-/postoperatively as well as three and six months after surgery. Statistical analysis was performed using Mann-Whitney U and Wilcoxon rank-sum test. RESULTS: The median age was 36.5 years. NRS improved from a median of 9.5 preoperatively to 3.0 (p < 0.001) at six-month follow-up. Median EQ-5D-5L index value before treatment was 0.18, indicating a notably lowered quality of life and increased up to 0.83 after six months (p < 0.001). Preoperative median BDI-V scores indicated a major depressive mood and improved from a median of 46.0 to 12.0 after six months (p = 0.007). Preoperative PCS was elevated with a median score of 41.0 and decreased to 4.0 after six months (p < 0.001). CSQ showed that patients were satisfied with the treatment. CONCLUSIONS: This unique method is an alternative and effective treatment option for CPP even years after primary endometriosis surgery.

A Retrospective Analysis of 25 Cases With Peripheral Nerve Field Stimulation for Chronic Low Back Pain and the Predictive Value of Transcutaneous Electrical Nerve Stimulation for Patient Selection.

OBJECTIVE: Transcutaneous electrical nerve stimulation (TENS) and peripheral nerve field stimulation (PNFS) may be proposed to patients with chronic lumbar pain refractory to conventional treatment. Aim of this study was to assess the importance of preoperatively treatment with TENS as a predictive value for later successful PNFS and impact of PNFS in follow-up of 12 months. METHODS: Between 2012 and 2016, a retrospective analysis of 25 patients with chronic lumbar pain and implantation of a PNFS-system was performed. Pain intensity (NRS), health-related quality of life (EQ-5D-5L), Oswestry disability index (ODI), actual mood state scale (ASTS), and treatment satisfaction (CSQ-8) were assessed pre/postoperatively, after 6 and 12 months. TENS use before surgery was assessed. RESULTS: The cohort consisted of 25 patients with a median age of 56 years (IQR25-75 51-63). In a subgroup analysis, 18 patients used TENS before surgery, 7 did not use TENS and were excluded. No pain relief was observed in 14 patients. Ten of these patients showed later positive effect in PNFS trial stimulation. In four patients, pain relief with TENS was seen. One patient later on had no benefit after PNFS trial, three had sufficient pain relief. In the whole cohort, five patients had no benefit after PNFS trial, in 20 patients a neurostimulator was implanted. NRS, EQ-5D-5L, and ODI measures showed significant improvement in the whole follow-up after PNFS implantation. ASTS scale showed an increase of values for positive mood and a reduction in values for sorrow, fatigue, and anger. In 55%, a sustained reduction in demand for analgesics was seen after 6 months, 50% after 12 months, respectively. CONCLUSION: In this retrospective analysis, TENS has no predictive value in the selection of patients with low back pain for the PFNS treatment. PNFS is effective and safe to relieve significantly symptoms of chronic low back pain.

The Risk for Fall and Functional Dependence in Polish Adults 60­87 Years Old.

The constantly rising percentage of the elderly (60+), who are particularly at risk of the dangerous consequence of falls, results not only in the loss of independence in daily life, but also in a serious threat to health and life. Therefore, many authors emphasize the necessity of conducting prophylaxis and prevention among senior citizens. The most important aspect of fall prophylaxis is care about the optimum level of agility. Exercise should focus on increasing muscular strength, balance and dexterity. The aim of the present study is to determine the relationship between functional fitness and the risk for falls of older people in the light of maintaining physical independence. The research group consisted of 522 persons: 142 males and 380 females aged 60-84 years from Wroclaw (a city in the south-west of Poland). All subjects provided written consent, and were measured and tested in 2009 through 2015, excluding the winter months. Body height and weight were measured. Body mass index was calculated. The Senior Fitness Test was used to assess functional capacity and efficiency. The results of the Senior Fitness Test were used to estimate Maintaining Physical Independence in Older Adults. The differences in the means of the results of all the tests between the age and sex-specific groups were assessed by means of a two-way analysis of variance, where sex and age were factors and results of appropriate test dependent variables. Logistic regression was used to estimate the risk for fall, based on the incidence of fall in the last year, for each test comparing the individuals met referenced criteria to maintain functionally dependence and independent, controlled for age and BMI. The risk for falls was more than twice greater in the case of the studied females, whose muscular strength of the upper part of the body was lower. The females in whose cases no fewer than two tests failed to ascertain functional independence, had a greater risk for falls. In the case of the males, no statistically-significant connections between functional independence and the risk for falls was found.

Chudley-McCullough Syndrome: Variable Clinical Picture in Twins with a Novel GPSM2 Mutation.

Chudley-McCullough syndrome (CMS) is a rare autosomal recessive disorder characterized by sensorineural deafness, agenesis of the corpus callosum, frontal polymicrogyria, interhemispheric cyst, and ventricular enlargement. CMS is caused by mutations in the GPSM2 gene, but until now no more than eight different mutations are on record. We describe two dizygotic twins with a novel homozygous loss-of-function mutation (c.1093C > T; p.Arg365*). While one child developed hydrocephalus-prompting shunt implantation immediately after birth, the other sibling did not. The combination of sensorineural hearing loss and partial agenesis of the corpus callosum is a highly recognizable clinico-radiological entity that should prompt mutational analysis of the GPSM2 gene.

[Myocardial infarction in the course of digoxin and theophylline poisoning].

The aim of this paper is to present a case of the patient who was hospitalized in the Toxicology and Cardiology Department because of suicidal digoxin and theophylline intoxication. Both drugs have complicated mechanism of action and affect cardiovascular system differently, but both predispose to ventricular and supraventricular arrhythmias. In the presented patient conduction disorders, cardiac muscle repolarization disorders and ventricular arrhythmias typical to digoxin poisoning were observed. During hospitalization the patient experienced the ECG and biochemical abnormalities resulting from myocardial infarction. In our paper we have analyzed digoxin and theophylline mechanisms of action and possible impact of each of these drugs on the clinical symptoms that our patient presented.

[Risk factors and treatment of patients with ST-segment elevation myocardial infarction with cardiogenic shock].

Aim: To assess risk factors and prognosis in patients with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock (CS) in Poland. Methods: Data from The Polish Registry of Acute Coronary Syndromes (PL-ACS) were analysed in 2008-2012. A total of 57400 consecutive STEMI patients included. The results of treatment and prognosis of patients with and without CS were compared. An additional analysis of the prognosis of men and women with CS was performed. Results: There were 34.2% of women and 65.8% of men. CS was diagnosed in 3589 (6.3%) patients (females 7.3% vs. males 5.7%, p<0.003). In multivariate analysis CS was the strongest factor affecting both inhospital (OR 2.51; 95%CI 2.25-2.80; p<0.0001) and 12-month (OR 2.09; 95%CI 1.96-2.24; p<0.0001) mortality. The worst prognosis was associated with pulmonary edema, advanced age, left or right bundle branch block, atrial fibrillation, and anterior MI. An early invasive strategy up to six hours from the symptom onset were the only factors reducing in-hospital and 12-month mortality. Despite of high female ratio in the group with CS and higher mortality in the female group, the female sex did not influence the in-hospital prognosis. Conclusion: In spite of enormous progress in the treatment of STEMI cardiogenic shock remains an important complication affecting the in-hospital and long-term prognosis. A symptom onset-to-treatment time is the key element in the management of patients with CS. Proper diagnosis and management including wide interventional strategy implementation increase the survival chance. An intensive study on novel treatment modalities and on effective identification methods of patients at risk and are warranted.

Destruction of the craniofacial skeleton in the child caused by an orbital tumor.

PURPOSE: The aims of this paper are to describe the morphological alterations within an infant craniofacial skeleton caused by an orbital tumor and present how the bone reacts in contact with a spreading tumor mass. METHODS: A study was performed on the dry skull of a child at the age of approximately 2 years. Morphological alterations of the craniofacial skeleton were analysed by visual inspection, and the intracranial cavity was examined with the aid of a digital camera. Subsequently, the skull was examined using computed tomography. RESULTS: The skull was identified as having unilateral symptoms of orbital destruction caused by a malignant tumor, probably retinoblastoma or rhabdomyosarcoma. The left orbit and surrounding bones showed extensive malformation caused by the invading tumor. Profound deformities were also observed in the nasal cavity, which was partially occluded by the collapsed medial wall of the left orbit. The tumor extended to the wall of the orbit, spread out of the orbit, penetrated to the anterior cranial fossa, and probably invaded the brain. CONCLUSIONS: Extensive pathological cranial destruction and possible metastases to inner organs suggest that the orbital tumor was the cause of death. Anatomical alterations observed in the craniofacial skeleton indicate a highly aggressive character of the orbital tumor.

A case of extensive inflammatory changes (osteomyelitis) in an infant's skeleton from the medieval burial ground (11th-12th c) in Wawrzenczyce (near Krakow).

The aim of this study was to diagnose and describe extensive inflammatory changes in a child's skeleton from Wawrzenczyce, (the medieval period). The aim of the analysis was to determine the nature of the inflammatory changes and their etiology by means of macroscopic techniques as well as X-ray analysis. The tests revealed that the individual suffered from a hematogenous multifocal osteitis. This condition might have been a result of an acute or sub-acute osteitis, and the untreated form of osteomyelitis might have contributed to the infection of the entire developing organism, leading to death.

PARENTAL PERCEPTION OF BODY WEIGHT IN PRESCHOOL CHILDREN AND AN ANALYSIS OF THE CONNECTION BETWEEN SELECTED PARENT-RELATED FACTORS AND THE ASSESSMENT OF THEIR CHILDREN'S WEIGHT.

INTRODUCTION: The efforts parents make to maintain the correct body weight in children indicates parental awareness of overweight and obesity-related health risks. AIM: The objective of the analysis was to define the accuracy of the appraisal of weight-to-height proportions in preschool children, as assessed by their parents and to analyse the connection of selected parental factors with the assessment conducted. MATERIAL AND METHODS: Data were collected from 230 children (121 males and 109 females aged 6.28 ± 0.56 years) attending preschools in the city of Wroclaw, Poland. Body height and weight were measured to calculate BMI; cut-offs referenced by the International Obesity Task Force were used to determine weight status (underweight, overweight, obese). The participants' parents completed a weight-height assessment of their child and provided information on how often the child's body weight was checked. Cohen's kappa coefficient was used as a statistical measure of inter-rater agreement between actual child weight and parental perception of child weight. Selected parental factors influencing the correctness of assessing child body weight was tested using the chi-square test. RESULTS: This study showed that 42.1% of underweight children and 60.9% overweight and obese children are perceived as having normal weight. In the group of children with normal weight-to-height proportions, 13.3% of the parents declared their normal-weight children to be underweight. No relationship was found in the study between the correct assessment of body weight and the parents' own body weight, their education, or such factors as sex and the frequency of checking the child's body weight. CONCLUSIONS: The incompatibility between actual and perceived weight status indicates the need for health education among parents in assessing and monitoring the child's body weight during the developmental period.