An improvement of body surface area formulas using the 3D scanning technique

OBJECTIVES

Body surface area (BSA) is one of the major parameters used in several medical fields. However, there are concerns raised about its usefulness, mostly due to the ambiguity of its estimation.

MATERIAL AND METHODS

Authors have conducted a voluntary study to investigate BSA distribution and estimation in a group of 179 adult people of various sex, age, and physique. Here, there is provided an extended analysis of the majority of known BSA formulas. Furthermore, it was supplement with a comparison with the authors' propositions of enhanced formulas coefficients for known formulas models as well as with new power models based on an increased number of anthropometric data.

RESULTS

Introduction of the enhanced formulas coefficients cause a reduction of at least 30.5% in mean absolute error and 21.1% in maximum error in comparison with their known counterparts.

CONCLUSIONS

In the context of the analysis presented it can be stated that the development of a single universal body surface area formula, based on a small number of state variables, is not possible. Therefore, it is necessary and justified to search for new estimation models that allow for quick and accurate calculation of body surface area for the entire population, regardless of individual body variations. The new formulas presented are such an alternative, which achieves better results than the previously known methods. Int J Occup Med Environ Health 2024;37(2).

The change in handgrip strength, after physical exercise, is moderated by digit ratio (2D:4D): A study among the young adults in Poland

BACKGROUND

The digit ratio (2D:4D), the ratio of the lengths of second (2D) to the fourth (4D) fingers, is a proxy indicator of prenatal androgen exposure. On average, males display lower 2D:4D than females. Previous studies have shown that lower 2D:4D ratios were associated with better sports and physical abilities.

AIM

To assess whether a challenge condition, imposed by intense exercise, could increase handgrip strength (HGS) associated with 2D:4D.

METHODS

This cross-sectional experimental study included 90 healthy young Polish adults (40 males, 50 females). They underwent intense physical exercise, before (7 days) and after which they were measured for HGS and 2D:4D. Height and weight were also measured. Analyses of Covariance were employed to delineate associations.

RESULTS

2D:4D had significant predictive effects on the differences in HGS (DHGS) measured in two occasions, without and after, physical exercises. The lower was the 2D:4D, the higher the DHGS, particularly, for the left hand.

CONCLUSION

The results reconfirmed that the link between prenatal testosterone exposure (indicated by 2D:4D) and physical strength depends on the context, such as a challenged condition.

Radiomorphometric indices of the mandible as indicators of decreased bone mineral density and osteoporosis - meta-analysis and systematic review

This review aims to evaluate the accuracy of various mandibular radiomorphometric indices in comparison with DEXA BMD measurements in the diagnosis of osteopenia and osteoporosis based on a meta-analysis of the sensitivity and specificity of the indices. PRISMA statement was followed. The materials for analysis were collected in August 2023 by searching three databases: PubMed Central, Web of Science, and Scopus. The selection of studies consisted of three selection stages, and 64 articles were finally obtained. Quality assessment was performed with the QUADAS-2 tool, and the general methodological quality of retrieved studies was low. Statistical analysis was performed based on 2 × 2 tables and estimated sensitivity and specificity were obtained using SROC curves. The most used indices were MCI, MCW and PMI. The best results in detecting reduced BMD obtained for MCW ≤ 3 mm, estimated sensitivity and specificity were 0.712 (95% CI, 0.477-0.870) and 0.804 (95% CI, 0.589-0.921), respectively. The most prone to the risk of bias is the MCI due to the examiner's subjectivism. Radiomorphometric indices of the mandible can be useful as a screening tool to identify patients with low BMD, but should not be used as a diagnostic method. Further research needs to focus on analysing the ability of the indices to detect osteoporosis and also in combination the indices with clinical parameters.

Is 2D:4D digit ratio related to avowed religion? A study among Mongolian young males from Ulaanbaatar

BACKGROUND

The ratio of the second- (2D) to fourth (4D) digit lengths of hand (2D:4D) is a proxy marker of the relative testosterone and estrogen concentration during a relatively narrow period of fetal development that might affect behavioral and personality characteristics.

AIM

To estimate the differences in 2D:4D between different religious groups among a sample of young adult males in Mongolia.

METHODS

Two hundred and sixty-five Mongolian male students with mean age of 20.5 (SD = 1.7) years from different universities in Ulan Bator, were included in the study. Information on age, religious affiliation, marital status and parental education were obtained directly from each study participant. Digit lengths were measured from scanned images by using the ImageJ software 1.53 K. One-way analysis of variance was employed to evaluate whether they were significant differences in 2D:4D ratio between groups, along with Scheffe's post hoc comparison.

RESULTS

Study participants significantly differed in 2D:4D across religion. Left 2D:4D, but not the right, showed a significant difference between religions, with Muslims exhibiting the highest 2D:4D mean and the lowest DR-L .

CONCLUSION

Our study suggests that the 2D:4D ratio is related to the participants' religion. However, the distinctiveness of the Muslim students from study participants belonging to other religious groups in this study could also be related to ethnic differences, given that the students were Kazakhs. This is, to our knowledge, the only study looking at the relationship between the 2D:4D ratio and religious affiliation and, thus, further research is needed to confirm its results.

Effect of Winter Outdoor Physical Activity on Body Composition and Motor Performance of Polish Adult Men

There is a relationship between physical activity and environmental factors, including weather conditions. Winter should not be a season in which physical activity is abandoned. Previous studies indicate that reducing the daily level of physical activity in adults has a negative impact on their motor proficiency and respiratory endurance, which subsequently translates into diminished quality of life. The aim of the study was to assess the impact of winter outdoor physical activity on somatic parameters, body composition, and motor performance of adult men (age 45.4 ± 5.9 years) involved in regular physical activity (physically active PA, n = 31) during the winter season (study group) compared to the control group of physically inactive men (PI, n = 22). Somatic parameters and selected parameters of motor fitness (Eurofit for Adults) were measured in both groups twice, at the beginning (pre) and at the end (post) of the winter season. An analysis of variance (ANOVA) with repeated measures and a post hoc LSD test were performed to evaluate the difference between the mean parameter values. In the PA group, a decrease in body fat mass, waist circumference, and abdominal obesity indicators, as well as an increase in skeletal muscle mass were confirmed. Improvements in motor performance parameters, i.e., flexibility, the speed of upper limb movements, hand and forearm muscle grip strength, the strength of the lower part of the torso, and cardiorespiratory endurance were also observed. Regular physical activity in the open air during the winter brings measurable health benefits, positively influencing the body composition and motor efficiency of adult men.

Do the short die young? Evidence from a large sample of deceased Polish adults

Body height is associated with various socioeconomic and health-related outcomes. Despite numerous studies, the relationship between stature and longevity remains uncertain. This study explores the association between self-reported height and lifespan. Data from 848,860 adults who died between 2004 and 2008 in Poland were collected. After excluding a small proportion of records due to missing data or errors, we examined records for 848,387 individuals (483,281 men, age range: 20–110 years; 365,106 women, age range: 20–112 years). Height was expressed as standardized residual variance derived from linear regression in order to eliminate the variance of year of birth on height. After the elimination of the cohort effect, five height classes were designated using centiles: very short, short, medium, tall and very tall. The differences between sexes and among classes were evaluated with two-way ANOVA and post hoc Tukey’s test. The effect size was assessed using partial eta squared (η2). Pearson’s r coefficients of correlation were calculated. The effect of sex on lifespan was nearly 17 times stronger than the effect of height. No correlation between height and lifespan was found. In conclusion, these findings do not support the hypothesis that taller people have a longevity advantage. We offer tentative explanations for the obtained results.

Blood Lead Level and Handgrip Strength in Preadolescent Polish Schoolchildren

Environmental pollutions, particularly toxic elements such as lead, are among the most significant factors affecting the growth and functional development of children. The aim of this study was to evaluate the effect of blood lead levels on handgrip strength (HGS) in urban children resident in the Copper Basin of Lower Silesia, Poland, controlling for the effects of chronological age, body size and socioeconomic status. The study included 165 boys (9−11 years of age) and 79 girls (9−10 years of age) from Polkowice town. Anthropometric measurements involved height, body mass and grip strength of the left and right hands. Maternal education was a proxy for socioeconomic status. Based on the median value of blood lead level (3.10 µg/dL), the two groups-below and above/equal median value-were defined. Analysis of covariance revealed that age (all p < 0.001), sex (at least p < 0.01), BMI (all p < 0.001), and blood lead level (at least p < 0.05) had a significant effect on the three indicators of HGS (right hand, left hand, average), while the level of maternal education did not significantly affect HGS (p > 0.05). The results of this study indicate a potentially negative effect of elevated blood lead level on grip strength in preadolescent children, irrespective of sex.

The Use of the Bioelectrical Impedance Phase Angle to Assess the Risk of Sarcopenia in People Aged 50 and above in Poland

Purpose: The increasing aging of many populations requires a continuous evolution of assessment methods in geriatrics, especially methods for identifying sarcopenia. Early diagnosis of unfavorable changes in the condition of skeletal muscles and the implementation of therapeutic methods may reduce the risk of functional limitations in the elderly. The aim of the study was to evaluate the association between the bioelectrical impedance phase angle and the occurrence of pre-sarcopenia in people aged 50 and above. Methods: 1567 people aged 50–87 were examined. Anthropometric as well as muscle strength and walking speed measurements were performed. Using bioelectrical impedance analysis, the phase angle was measured and the appendicular skeletal muscle mass was estimated. The contribution of the phase angle in explaining the probability of the occurrence of pre-sarcopenia was verified by multivariate logistic regression. Results: Sarcopenia was diagnosed in 12 people (0.8%) and pre-sarcopenia in 276 people (17.6%). Significantly lower impedance phase angle and muscle functional quality were found in people with confirmed pre-sarcopenia compared to people without sarcopenia. The relative differences for the phase angle were greater than for the indicator of muscle functional quality. Significant logit models were obtained for the probability of occurrence of pre-sarcopenia, in which the strongest predictor was the phase angle, regardless of the type and number of covariates. The cut-off point of the phase angle for identification of pre-sarcopenia was 5.42° in men and 4.76° in women. Conclusion: The strong association between the risk of pre-sarcopenia and the phase angle, which can be easily and quickly assessed by bio-impedance analysis, suggests the necessity to include this parameter in routine geriatric evaluation in order to identify the risk of sarcopenia.

Maternal genetic origin of the late and final Neolithic human populations from present-day Poland

OBJECTIVE

We aim to identify maternal genetic affinities between the Middle to Final Neolithic (3850-2300 BC) populations from present-day Poland and possible genetic influences from the Pontic steppe.

MATERIALS AND METHODS

We conducted ancient DNA studies from populations associated with Złota, Globular Amphora, Funnel Beaker, and Corded Ware cultures (CWC). We sequenced genomic libraries on Illumina platform to generate 86 complete ancient mitochondrial genomes. Some of the samples were enriched for mitochondrial DNA using hybridization capture.

RESULTS

The maternal genetic composition found in Złota-associated individuals resembled that found in people associated with the Globular Amphora culture which indicates that both groups likely originated from the same maternal genetic background. Further, these two groups were closely related to the Funnel Beaker culture-associated population. None of these groups shared a close affinity to CWC-associated people. Haplogroup U4 was present only in the CWC group and absent in Złota group, Globular Amphora, and Funnel Beaker cultures.

DISCUSSION

The prevalence of mitochondrial haplogroups of Neolithic farmer origin identified in Early, Middle and Late Neolithic populations suggests a genetic continuity of these maternal lineages in the studied area. Although overlapping in time - and to some extent - in cultural expressions, none of the studied groups (Złota, Globular Amphora, Funnel Beaker), shared a close genetic affinity to CWC-associated people, indicating a larger extent of cultural influence from the Pontic steppe than genetic exchange. The higher frequency of haplogroup U5b found in populations associated with Funnel Beaker, Globular Amphora, and Złota cultures suggest a gradual maternal genetic influx from Mesolithic hunter-gatherers. Moreover, presence of haplogroup U4 in Corded Ware groups is most likely associated with the migrations from the Pontic steppe at the end of the Neolithic and supports the observed genetic distances.

The effect of a natural disaster on handgrip strength in prepubertal Indian children exposed to a severe cyclone during the prenatal and early postnatal growth

Natural disasters (NDs) experienced by women and their children during prenatal and infant growth may have long-lasting effects on offspring’s development. Handgrip strength (HGS) is one of the measures of muscular strength and an indicator of health status. This study compared HGS in children exposed to cyclone Aila in India during their prenatal and infant growth compared to a control group from a non-affected, adjacent area. The total sample involved 444 boys and 423 girls aged 7–9 years, categorised into 3 groups: prenatally exposed to Aila, exposed to Aila in infancy, and the control group, non-exposed to Aila. Results revealed that prenatally exposed children of both sexes had significantly lower HGS than the controls (at least, p < 0.001 in boys; p < 0.05 in girls). On the other hand, the postnatally exposed boys, but not the girls, showed lower HGS than the controls. A significant effect of a group factor (ND exposure) on HGS was observed even after controlling for confounding variables (age, height, BMI, birth weight, gestational age; at least, p < 0.05). Our findings indicate that prenatal or early postnatal experience of a ND may have association with impaired HGS in prepubertal children.

Shifts in Female Facial Attractiveness during Pregnancy

It has been proposed that women’s physical attractiveness is a cue to temporal changes in fertility. If this is the case, we should observe shifts in attractiveness during pregnancy—a unique physiological state of temporal infertility. The aim of this study was to examine how women’s facial attractiveness changes during the subsequent trimesters of pregnancy and how it compares to that of nonpregnant women. Sixty-six pictures of pregnant women (22 pictures per trimester) and 22 of nonpregnant women (a control group) were used to generate four composite portraits, which were subsequently assessed for facial attractiveness by 117 heterosexual men. The results show considerable differences between facial attractiveness ratings depending on the status and progress of pregnancy. Nonpregnant women were perceived as the most attractive, and the attractiveness scores of pregnant women decreased throughout the course of pregnancy. Our findings show that facial attractiveness can be influenced by pregnancy and that gestation, even at its early stages, affects facial attractiveness. Considerable changes in women’s physiology that occur during pregnancy may be responsible for the observed effects.

Socio-economic determinants of the somatic development and reaction time of vegetarian and non-vegetarian children

Introduction: Vegetarian diet is increasingly used in both adults and children. Study aim: The aim of the study was to determine the differences in the body build and reaction time of vegetarian and non-vegetarian children on the background of socio-economic factors. Material and methods: The material consisted of 218 children, including 47 vegetarians (25 boys and 22 girls) and 171 non-vegetarians (93 boys and 78 girls) from 3 to 15 years. The research consisted of a survey and measurements. The survey included questions such as date of birth, child's birth parameters (length, weight, Apgar scores), child's diet (vegetarian/non-vegetarian), mother's diet during pregnancy (vegetarian/non-vegetarian), breastfeeding (yes/no), number of months of breastfeeding, mother's diet during lactation (vegetarian/non-vegetarian), maternal and parental education level (elementary / trade/ college / university), living conditions and the number of siblings. The height and body mass, skin-fat folds on the abdomen, shoulder and arm (sum of 3 skinfolds) were measured, BMI was calculated and the reaction time was assessed using the Quickstick ruler. The General Linear Model, Wald's test, U-Mann-Whitney test and Principal Components Analysis were applied. Results: The results showed that vegetarian children who came from families with a higher socio-economic status than non-vegetarian were significantly longer breastfed. The somatic build of vegetarian children, including height, BMI and the sum of three skinfolds significantly differed from non-vegetarian children. The vegetarian children were shorter, with lower BMI and lower sum of the three skinfolds, as well as their reaction time was longer. Conclusions: Vegetarian diet affects the height, BMI and body fatness, as well as the reaction time in children at the age of 3-15.

Endoscopic Ultrasound-Guided Treatment of Gastric Varices Using Coils and Cyanoacrylate Glue Injections: Results after 1 Year of Experience

Background and Aims: Gastric varices (GVs) occur in 20% of patients with portal hypertension. GVs are associated with a 65% risk of bleeding over the course of 2 years and have a mortality rate of up to 20%. The standard treatment for GVs is obliteration with cyanoacrylate (CYA). This study presents our experience with combined therapy (vascular coils and CYA) under endoscopic ultrasound (EUS) guidance. Methods: 16 patients (9 male and 7 female) were included into our study. Etiology of portal hypertension included: portal vein thrombosis (PVT) (31.0%), isolated splenic vein thrombosis (SVT) (25.0%), alcoholic cirrhosis (12.5%), hepatitis C cirrhosis (19.0%), and alcoholic cirrhosis with PVT (12.5%). Varices type GOV-2 were diagnosed in 8 patients, type IGV-1 and IGV-2 in 6 and 2 patients, respectively. Indications for treatment were based on endoscopic and endosonographic evaluations of GVs. Inclusion and exclusion criteria were also specified. Technique depended on the size of varices (different size of coils + CYA additionally). The results were based on the achievement of technical success, therapeutic effects, and number of adverse events. Average follow-up period was 327 days. Results: From January to August 2017, 16 patients were treated with EUS-guided obliteration of GVs using vascular coils only or coils with CYA injections. 6 (37.5%) and 10 (62.5%) patients underwent primary and secondary prophylaxis for hemorrhage, respectively. Technical success was achieved in 15 patients (94.0%). Mean numbers of implanted coils and CYA volume during one procedure were 1.7 and 2 mL, respectively. Therapeutic success was achieved in all patients treated with the combination. There were no serious complications such as embolization or death due to the procedure. Three patients (19.0%) had transient abdominal pain and two (12.5%) had transient fever. 1 patient had clinical symptoms of gastrointestinal bleeding. Conclusions: Based on our retrospective research we have concluded, that EUS-guided implantation of intravascular coils combined with cyanoacrylate injections is an effective method of treatment with an acceptable number of complications.

Exposure to parental smoking during pregnancy and handgrip strength in 7-10-year old children

BACKGROUND

Maternal smoking during pregnancy is a risk factor associated with intrauterine growth retardation and postnatal complications.

AIM

To assess the relationship between prenatal exposure to smoking on hand grip strength in children 7-10 years of age.

STUDY DESIGN

Generalized Linear Model (GLM) was used to assess the relationship between grip strength and smoking status of parents, controlling for social status, birth outcome and body size.

OUTCOME MEASURES

Height, weight and hand grip strength were measured by trained staff. Smoking status of both parents during pregnancy, mother's level of education and birth outcome were reported by questionnaire.

SUBJECTS

734 records (297 boys, 437 girls) of healthy children aged 7-10 years from a survey conducted in 2001-2003 in randomly selected primary schools of Łódź.

RESULTS/CONCLUSION

Boys exposed to both maternal and paternal smoking during prenatal life showed lower muscular strength at 7-10 years, but a similar relationship was not observed in girls. Intrauterine hypoxia due to maternal smoking during pregnancy and subsequent postnatal exposure to maternal and paternal smoking may have attenuated the formation and subsequent development of muscle fibres in boys.

Digit ratio (2D:4D) moderates the change in handgrip strength on an aggressive stimulus: A study among Polish young adults

BACKGROUND

The ratio of the lengths of second finger (2D) to the fourth (4D) is a putative indicator of foetal hormonal exposure. The link between 2D:4D and physical strength or sports performance in not consistent. It was suggested that the association of 2D:4D with the sporting and physical ability is better demonstrated in the context of challenge and competition, either real or simulated. However the evidence is limited to a few studies till date.

AIM

The objective of this study was to assess whether an aggressive video show could increase muscular strength and if 2D:4D moderated such increase.

STUDY DESIGN

We compared outcome measures in two experimental conditions.

OUTCOME MEASURES

Lengths of second (2D) and fourth (4D) digits and their ratio (2D:4D) for both hands, height and weight, handgrip strength of both hands.

SUBJECTS

250 healthy young adults (76 female).

RESULTS

The mean left-, right- and average HGS values increased after aggressive video watching than after control blank screen show. The increase was higher in females compared to males. The increase was higher among the individuals with lower 2D:4D, more clearly among females.

CONCLUSIONS

The 2D:4D correlated negatively with HGS after exposure to challenge condition and this relationship is pronounced in females than males. Thus there is link between prenatal androgenisation and enhanced physical power in challenge situation.

Age at maturation, body structure and their relationship with socioeconomic factors

Introduction: In this study, we aimed to identify the differences in body structure between early, average, and late maturing girls, taking into account family characteristics assessing socio-economic and living conditions. Methods: This study was conducted in the years 2003 and 2013 in Warsaw, Poland and comprised 788 girls in the age group of 11-19 years. The data were collected using a questionnaire which included parental education and profession, girls' date of birth, age at menarche, and lifestyle characteristics. The measurements included height; weight; skinfolds on arm, under scapula, and on abdomen; arm circumference; and body mass index (BMI). The girls were divided into three groups: early, average, and late maturing. To eliminate the age differences, for each of the examined somatic variable, a "z" score was calculated. We analysed the combined data of both years (2003 and 2013) due to the lack of difference in the mean age at menarche. The primary objective of this study was to assess the relationship between somatic body structure and socioeconomic and lifestyle factors among early, average, and late maturing girls. Results: Early maturing girls possessed higher body weight and BMI. In families with only one child, the age at menarche was found to be the earliest than in families with more than one child. Body weight, BMI, arm circumference, and fatfold thickness was found to be reduced in case of girls whose parents had better education and profession than their peers. Higher levels of stress were associated with higher body mass, greater BMI, arm circumference, and skinfolds in early maturing girls. The associations between body structure with physical activity and family was mainly correlated with body weight and BMI. Conclusion: Socioeconomic and lifestyle factors may be helpful in some levelling of differences in the body structure between girls differing in the age at menarche, especially the level of stress and the education and profession of parents.

Parental smoking during pregnancy and head shape and size in school children

BACKGROUND

Maternal smoking during pregnancy has been recognised as a detrimental factor associated with adverse perinatal outcomes; however, to date there is a dearth of information on how it affects post-natal head growth and shape.

AIM

To assess the relationship between parental smoking exposure during pregnancy and head dimensions and shape at age 7-10 years in boys and girls.

METHODS

Body height and head length, breadth and circumference were measured. Birth weight and gestational age were obtained from the children's medical record books. Parental smoking habits during pregnancy and maternal educational attainment were obtained by a questionnaire. The relationship between exposure to parental smoking during pregnancy and head dimensions was evaluated using analysis of covariance implemented in the Generalized Linear Model, separately for each sex.

RESULTS

Maternal and parental smoking during pregnancy significantly altered head shape in boys by affecting head length, while neither head breadth nor circumference were affected. This phenomenon was not observed in girls.

CONCLUSION

Smoking-induced chronic hypoxic effects on the growing foetus, indicated that both active and passive smoking during pregnancy seems to have persistent negative effects on children, going beyond foetal development and pre-natal growth restrictions.

Do skin and hair pigmentation in prepubertal and early pubertal stages correlate with 2D:4D?

OBJECTIVES

In most human populations women are less pigmented than men. However, before puberty, boys tend to have lighter skin than girls. Previous research has shown that skin pigmentation in European women is negatively correlated with digit ratio (2D:4D). Therefore, it has been hypothesized that skin pigmentation in females is partially controlled by prenatal hormones. The aim of this study was to examine the correlation between 2D:4D and pigmentation in girls and boys in the prepubertal or early pubertal stages of ontogenesis.

METHODS

The study group consisted of 598 Polish children (275 boys), aged 6.5-10.5 years. All underwent spectrophotometric measurements of skin and hair melanin index (SMI and HMI) and had the second and the fourth finger on both hands measured directly.

RESULTS

SMI (in girls) and HMI (in girls and boys) were positively correlated with age but 2D:4D was not. We regressed SMI and HMI on age and used the residuals as a measure of age-independent pigmentation. In girls, positive correlations were found between resSMI and 2D:4D for the right hand, but there was no correlation with left 2D:4D. In boys, resSMI did not correlate with 2D:4D. The resHMI was not related to 2D:4D in girls or boys.

CONCLUSION

Skin pigmentation in prepubertal or early pubertal girls is related to 2D:4D such that high 2D:4D is associated with higher pigmentation. This relationship may be mediated by the individual rate of sexual maturation.

Can the surgeon live his whole life? Analysis of the risk of death related to the profession

More than half of physicians in Poland are over 50 years old. This raises concerns about the risk of lack of continuity of health care services due to the generational gap, particularly marked among interventional specialties. The physical and mental burden of general surgery affects those doctors in particular. The aim of the study is to assess whether the type of the profession pursued influences the average lifetime of a physician in Poland and the impact of the surgeon's occupation on life expectancy compared to the rest of the population according to gender. Demographic data was obtained from official publications of the Central Statistical Office. Data on 189,459 physicians in Poland were obtained from the Central Register of Doctors. A total of 6,496 physicians and dentists deaths in the period from January 1st, 2010 to June 30th, 2014, including 722 surgeons, were analyzed. In general, both male physicians and dentists died at an older age than the mean population (74.9 years and 74.7 years vs. 68.9 years; p &lt;0.05). Among women, only dentists lived longer (78.5 years) p &lt;0.05), while women physicians died at a younger age than the average in the general population (76.4 vs. 77.2 years; p &lt;0.05). The average lifetime of both male and female surgeons was 74.2 and 77.5 years, respectively. The average life expectancy of people aged 25 years with college/university education is 80.3 years for men and 86.6 years for women. Male surgeons live significantly longer than the average life expectancy in the general population of men. The average length of life of women surgeons is significantly lower than the average lifespan of women in the general population. The actual lifetime of surgeons in Poland is significantly lower than the expected average life expectancy for other people aged 25 with tertiary education. The average lifespan of surgeons in Poland does not differ significantly from the average life expectancy of other Polish physicians.

Factors influencing inguinal hernia symptoms and preoperative evaluation of symptoms by patients: results of a prospective study including 1647 patients

Background

Current recommendations for hernia treatment suggest applying techniques aimed at reducing postoperative pain in patients experiencing intense preoperative pain. However, there is still no reliable stratification method of preoperative pain, its circumstances, intensity and frequency, and the current assessments of hernia symptoms are performed by means of a subjective evaluation. The aim of this work is to discuss preoperative pain before hernia repair and determine its nature depending on the type and length of hernia persistence and the patient’s age.

Materials and methods

The data from 1647 patients before inguinal hernia repairs (2010–2017) were registered prospectively in the National Hernia Repair Register (demographic data, pain score and influence on everyday activities).

Results

The most common symptom upon admission was pain (949 patients at rest; 57.6% and 1561 at physical activity; 94.8%). A significant influence of hernia persistence on the pain occurrence and intensity was not observed between patients with hernia < 12-months (60.8%;VAS5.0) and > 5-years (58.3%;VAS5.4) (p = 0.068). The occurrence and intensity of pain was significantly higher patients < 40-years (63.7%;VAS5.4) than patients > 60-years (54.3%;VAS4.8) (p = 0.008).

Conclusions

While pain at rest is not a significant problem, undertaking physical activities may intensify pain and increase the number of patients suffering from it. Preoperative assessment of pain may help determine the group of younger patients who could benefit the most from inguinal hernia repair. New indications for prompter admission for treatment should be planned in future studies of patients showing pain at rest for possible prevention of postoperative neuropathy.

The influence of different sterilization types on mosquito net mesh characteristics in groin hernia repair

Background

In low-resource countries, a suture repair is still in common use due to the limited access to commercial mesh implants. The search for less expensive alternatives to the synthetic meshes has led to using mosquito nets. Sterilized mosquito net appears to be a low-cost and commonly available product that closely resembles commercially available meshes. However, the extent to which sterilization alters the structure of mosquito nets is still unknown. The aim of this research was to assess the effects of different sterilization types on physico-mechanical properties of mosquito nets.

Materials and methods

Nine different polymers were analyzed (six mosquito nets from low-resource countries, one European net, and two commercial meshes). The analyzed parameters included: polymer type, net surface area, fiber diameter, net thickness, mesh weight, pore size, tensile strength, and tear force. The measurements were taken before sterilization, after sterilization at 121 and at 134 °C.

Results

Sterilization altered net surface and pore size, but did not significantly alter the single fiber diameter, weave of filaments, or net thickness. Steam sterilization did not affect the tensile strength or tear force.

Conclusions

The reduction of the mosquito net surface area by more than 40% due to sterilization at 121 °C, results in a loss of macroporous structure, turning the mesh into hard, shrunken, non-pliable masses. Sterilization at 134 °C causes some mosquito nets to melt and completely destroys their porous structure. Maximum pressure in the abdominal cavity is higher than the tensile strength and tear force of some locally available mosquito nets; therefore, these nets should not be used.

Anthropometric predispositions for swimming from the perspective of biomechanics

PURPOSE

Early identification of anthropological potential in swimmers is considered important to the recruitment and selection of children and adolescents to perform extensive and strenuous training. The aim of the research was a comparative analysis of the anthropometric parameters and indicators of adult, elite swimmers with people who had never trained for swimming. It was assumed that the specific characteristics of the swimmers' somatic composition referred to the laws of swimming biomechanics.

METHODS

Anthropometric measurements were taken in a group of elite male swimmers (N = 28), aged 17-24. The same set of measurements was taken in a homogeneous control group of students of physical education. An anthropometric profile significantly differentiating swimmers from the control group was constructed. Next, a linear forward stepwise discriminant analysis was conducted to investigate which indices can be used to distinguish the two groups.

RESULTS

It seems significant that a specific somatic composition trait of swimmers in the form of a relatively long shank was observed, which had not been observed in earlier studies. Additionally, indices of relatively slim hand dimension, and indices describing a "reversed triangle" shape of trunk, were the most powerful discrimination variables between the two examined groups.

CONCLUSION

The results obtained cannot be generalised to the entire population of swimmers, however referring them to the laws of biomechanics of swimming allows for the continuation of research into identifying the prognostic traits desirable for success among young swimmers.

Relationship between temperament and fatness in 11-year-old children and 17-year-old adolescents from Wrocław, Poland

Childhood obesity is increasing globally, and Poland is no exception. Studies indicate that relationship between obesity and psychological well-being is a complex issue and this needs further research. The objective of the present cross sectional study was to analyze the relationship between some temperament components and fatness among children in two developmental periods, approximately before and after adolescence. Participants included 122 children aged 11 years (57 boys and 65 girls), and 153 adolescents aged 17 years (64 boys and 89 girls) from 6 primary and 4 secondary schools in Wrocław, Poland. Height, weight, triceps-, subscapular and abdominal skinfold thicknesses were measured. Temperament was assessed by a questionnaire of Buss and Plomin (1984) in two versions: EAS-C for children completed by parents and EAS-D for youth and adults. Physical activity (PAL) was also assessed by a questionnaire. Mean, median and standard deviation (SD) were calculated and Student's t tests were performed to test for significance of differences between groups. Chi squared (χ²) statistic was used to test the significance of differences in frequencies. Analyses of covariance (ANCOVA) were performed to show the effect of the social - psychological factors on fatness. Controlling for socioeconomic status and physical activity level, activity, as a component of temperament had a significant effect on body fatness. The only component of temperament, which significantly influenced level of fatness in girls, was emotionality. These relationships differed according to sex and the two age groups concerned.

Effect of marital distance on birth weight and length of offspring

Marital distance (MD), the geographical distance between birthplaces of spouses, is considered an agent favouring occurrence of heterosis and can be used as a measure of its level. Heterosis itself is a phenomenon of hybrid vigour and seems to be an important factor regulating human growth and development. The main aim of the study is to examine potential effects of MD on birth weight and length of offspring, controlling for socioeconomic status (SES), mother’s age and birth order. Birth weight (2562 boys and 2572 girls) and length (2526 boys, 2542 girls) of children born in Ostrowiec Swietokrzyski (Poland) in 1980, 1983, 1985 and 1988 were recorded during cross-sectional surveys carried out between 1994-1999. Data regarding the socio-demographic variables of families were provided by the parents. Analysis of covariance showed that MD significantly affected both birth weight and length, allowing for sex, birth order, mother’s age and SES of family. For both sexes, a greater marital distance was associated with a higher birth weight and a longer birth length. Our results support the hypothesis that a greater geographical distance between the birth places of parents may contribute to the heterosis effects in offspring. Better birth outcomes may be one of the manifestations of these effects.

The level of physical fitness in children aged 6-7years with low birthweight

BACKGROUND

Level of physical fitness is related to the functional status of most of the bodily functions and so it appears to be very important to identify perinatal factors influencing physical fitness.

AIM

The purpose of this study was to determine the influence of birth weight on the level of physical fitness in children 6-7years of age.

SUBJECTS AND METHOD

Physical fitness was assessed using EUROFIT tests in 28,623 children, aged 6-7years, from rural areas in Poland. Children below the 10th percentile for birth weight for gestational age were defined as small for gestational age (SGA). The influence of birth weight on parameters of fitness was assessed by means of covariance analysis.

RESULTS

With the controls of age, sex and body size, children of low birth weight have shown significantly lower levels of body flexibility and running speed. The leg strength of children with SGA turned out to be significantly lower only in 7-year-old boys.

CONCLUSION

This study has revealed the significant influence of birth weight on physical fitness. The results suggest the importance of early intervention and its possible benefits for developing and maintaining the proper level of physical fitness further in life.

Body structure and maturation – the association with environmental factors

The main objective of the study was to determine the relationship between physique, maturation and some environmental factors. The study was conducted in Warsaw, between 2012 and 2013 in randomly selected schools. The material included 171 girls, aged 12–20 years. Body height and weight, upper and lower extremity length, subcutaneous fat folds on arm, subscapular and abdominal, circumferences of arm, chest, waist and hip were measured. Body proportion indices were calculated. The questionnaire form provided information on parental education and profession, and the number of children in family. Girls were asked about age at menarche, number of daily meals, level of physical activity, participation is sport, and level of stress at home and at school. The principal component analysis was applied and 4 factors were extracted from the set of living condition characteristics (F1 – Parental education & father’s occupation, F2 – Mother’s occupation and the number of children, F3 – Stress, F4 – Physical activity and number of daily meals). Regression analysis allowed to evaluate the association of body build characteristics and age at menarche with the four factors. Factor 1 and 4 were the only ones which showed a statistically significant association with body build. The results showed that girls who were taller, with smaller arm and waist circumferences and less adiposity came from families with higher parental education and better father’s profession. Taller stature, longer legs and less adiposity characterized girls who were more physically active and consumed more than three meals a day.

Functional capacities of Polish adults of 60-87 years and risk of losing functional independence

AIM

To characterise the functional capacities of Polish men and women aged 60-87 years and evaluate their status relative to criteria for functional independence.

SUBJECTS AND METHODS

Four hundred and thirty-one women and 125 men, aged 60-87 years, who were residents of Wrocław, southwestern Poland, were recruited. Height and weight were measured and BMI was calculated. The Fullerton Functional Fitness Test was administered to test upper and lower body strength, upper and lower body flexibility, agility-dynamic balance and aerobic endurance. The Paffenbarger physical activity questionnaire was completed. Characteristics of individuals classified by the number of tests which equalled or exceeded criterion-referenced standards for functional independence (excluding flexibility) were compared.

RESULTS

Polish older adults compared favourably to American reference values. Percentages meeting the criteria for all four, for two or three and for one or no tests were, respectively, 21%, 54% and 25% in women and 37%, 45% and 18% in men. Adults meeting the criteria for all four tests were lighter, with a lower BMI and more physically active than those meeting the criteria on two or three tests and on one or no tests.

CONCLUSION

The majority of Polish older adults were not at risk for loss of physical independence. The most functionally independent adults of both sexes had a lower BMI and less obesity, and were physically more active; the converse was true for those not meeting the criteria.

Analysis of factors affecting the development of hypocalcaemia after multinodular goitre surgery

INTRODUCTION

Thyroidectomy is a common surgery performed especially in treatment of multinodular goitre. The most common post-thyroidectomy complication is a postoperative hypocalcaemia, and the percentage of postoperative hypoparathyroidism could reach even 50%. Tested group and methods: A forward-looking, randomized testing was done on a group of 113 women being subject to multinodular goitre surgery. In this article, we wish to present an analysis of the results obtained in the control group, focusing on the predicative factors which determine the development of postoperative hypocalcaemia. Obtained results: The rate of postoperative biochemical hypocalcaemia development was significantly higher in the group of patients, where the preoperative calcium concentration was lower than 2,4 mmol/l. In that group, the development of biochemical hypocalcaemia was observed in 93,7% of cases (30 out of 32 patients), in comparison with 65,3% (17 out of 26) in the group of higher preoperative concentration of calcium. The highest risk of occurrence of postoperative hypocalcaemia was borne by the total thyroidectomy, while the lowest one by the subtotal thyroid lobectomy of one lobe only.

CONCLUSIONS

A higher preoperative concentration of calcium in blood serum is related to the lower rate of occurrence of postoperative biochemical hypocalcaemia. However, no such correlation was revealed in the case of postoperative symptomatic hypocalcaemia. Lack of correlation was determined between the preoperative concentration of TSH and FT4 in blood serum and the rate of occurrence of postoperative hypocalcaemia, both symptomatic and asymptomatic. The performed statistics did not reveal a relation between the postoperative hypocalcaemia and the duration of the surgery, but a significant correlation was stated with the scope of the performed surgery. Revealing a relation between the rate of occurrence of postoperative hypocalcaemia and the experience of the surgeon performing the surgery was not successful.

Infeasibility of endoscopic transmural drainage due to pancreatic pseudocyst wall calcifications - case report

Postinflammatory pancreatic pseudocysts are one of the most common complications of acute pancreatitis. In most cases, pseudocysts self-absorb in the course of treatment of pancreatitis. In some patients, pancreatic pseudocysts are symptomatic and cause pain, problems with gastrointestinal transit, and other complications. In such cases, drainage or resection should be performed. Among the invasive methods, mini invasive procedures like endoscopic transmural drainage through the wall of the stomach or duodenum play an important role. For endoscopic transmural drainage, it is necessary that the cyst wall adheres to the stomach or duodenum, making a visible impression. We present a very rare case of infeasibility of endoscopic drainage of a postinflammatory pancreatic pseudocyst, impressing the stomach, due to cyst wall calcifications. A 55-year-old man after acute pancreatitis presented with a 1-year history of epigastric pain and was admitted due to a postinflammatory pseudocyst in the body and tail of pancreas. On admission, blood tests, including CA 19-9 and CEA, were normal. An ultrasound examination revealed a 100-mm pseudocyst in the tail of pancreas, which was confirmed on CT and EUS. Acoustic shadowing caused by cyst wall calcifications made the cyst unavailable to ultrasound assessment and percutaneous drainage. Gastroscopy revealed an impression on the stomach wall from the outside. The patient was scheduled for endoscopic transmural drainage. After insufflation of the stomach, a large mass protruding from the wall was observed. The stomach mucosa was punctured with a cystotome needle knife, and the pancreatic cyst wall was reached. Due to cyst wall calcifications, endoscopic drainage of the cyst was unfeasible. Profuse submucosal bleeding at the puncture site was stopped by placing clips. The patient was scheduled for open surgery, and distal pancreatectomy with splenectomy was performed. The histopathological examination confirmed the initial diagnosis of postinflammatory pancreatic pseudocyst. Endoscopic transmural drainage is a highly effective procedure for treating postinflammatory pancreatic pseudocysts. In some patents, especially with large pseudocysts, pseudocysts with calcified walls, and cysts of primary origin, resection should be performed.

Overall trends vs. individual trajectories in the second-to-fourth digit (2D:4D) and metacarpal (2M:4M) ratios during puberty and adolescence

OBJECTIVES

The second-to-fourth digit ratio (2D:4D ratio) can be assumed a valid indicator of sexual differentiation, provided that it is stable once it develops, or eventual changes remain uniform in a respective cohort throughout ontogenesis. The main goal of this study was to determine whether the metacarpal 2M:4M and the digit 2D:4D ratio change during the period of pubertal/adolescent growth.

MATERIALS AND METHODS

The metacarpals and digits were measured on radiographs of left hands in the sample of 328 individuals (96 pairs of male and 68 pairs of female twins) from the Wrocław Longitudinal Study of Twins (1967-1983). Five consecutive annual measurements were done for each individual within a 4-year-interval somewhere between 7 and 18 years of age. Age-related changes in both ratios were studied using a set of mixed-effects linear models. Three types of correlation coefficients were used for assessment of stability between repeated measurements at different ages.

RESULTS

An overall decrease in the average 2M:4M ratio was observed, attributable to a much larger extent to males than to females. On the contrary, a slight overall increase in the average 2D:4D ratio was observed, attributable to a much larger extent to females than to males. The rank order of the ratios remained highly stable within the monitored period (the correlation coefficient mostly ranged between 0.85 and 0.95). In spite of these findings, we recorded significant intraindividual changes in both ratios. In some individuals the 2D:4D ratio can undergo changes comparable to average sex differences and much higher than average age-related changes.

DISCUSSION

Relatively slight overall changes in digit ratio in puberty and adolescence themselves are not inconsistent with the use of the 2D:4D ratio as an indirect marker of prenatal sexual differentiation. Nevertheless, individual changes in the ratios varied substantially in this study and differed from the average trends. Future studies should focus on the nature of interindividual developmental differences in the digit and metacarpal ratios.

The association between social factors and body length proportions in Polish schoolchildren from Lower Silesia

Many studies worldwide have shown that social factors are significantly associated with growth in childhood. However, very few researchers studied influence of social factors on body length proportions. The aim of the present study was the assessment how urbanization level, sibship size and parental education may affect body length proportions in schoolchildren. 325 boys and 335 girls aged 7-18 years were measured in schools in Wrocław, two small towns and villages around these towns. Height, sitting height, leg length , and lower leg length were measured in all children, then relative lengths (in relation to height) were calculated: leg, femur, lower leg, estimated leg and lower leg length to leg length ratio. Height was standardized on age using LMS parameters for CDC 2002 year cohort. Other indices were standardized on age by using residuals variance derived from linear regressions. Four-way analysis of variance was used for height and each index, where independent variables were four social factors. Except for father’s education in boys, no other social factor was significant associated with height. Urbanization level significantly differed almost all indices, whereas father’s education level was significantly associated with relative leg length in girls and estimated leg length in both sexes. Our study has shown that the segments of lower limb seems to be more sensitive than height to the effect of social factors. In Lower Silesia, the level of urbanization is still related to differences in environmental conditions, enough to significantly affect growth of children, especially within the segments of lower limbs.

Secular trends in body weight and length of children aged 0–2 years. Longitudinal study of five consecutive birth cohorts between 1964–2003 from Wrocław, Poland

The aim of this work is to evaluate the intensity of possible secular trends among the five subsequent cohorts of Wrocław (Poland) children aged 0, 6, 12 and 24 months. This document describes secular changes in the body length, weight and the Rohrer’s index. Material: Research material represent the longitudinal studies of five consecutive birth cohorts. The first study involved children born during 1963–1965, and the last in 2003–2005. All of the studies were related to the same social group and were conducted using the same methodology. There are differences in the intensity and direction of the secular trends in children depending on their age. In both sexes the body length of newborns kept increasing until the end of the nineties and decreased in the last decade. The body weight did not change during the 40-year period. This suggests an important role of maternal regulator in fetal development and therefore no clear response to external environmental factors. Secular changes such as the body length and weight, which are the most adequate to the economic changes in Poland, were observed in children aged 6 and 12 months. It may be a result of their highest ecosensitivity during this period. However, there have not been any clear trends observed in the 24 months age group. This may be due to the increasing participation of genetic factors in the development of the child.  

Parental smoking during pregnancy shortens offspring's legs

One of the most severe detrimental environmental factors acting during pregnancy is foetal smoke exposure. The aim of this study was to assess the effect of maternal, paternal and parental smoking during pregnancy on relative leg length in 7- to 10-year-old children. The research conducted in the years 2001-2002 included 978 term-born children, 348 boys and 630 girls, at the age of 7-10 years. Information concerning the birth weight of a child was obtained from the health records of the women. Information about the mother's and the father's smoking habits during pregnancy and about the mothers' education level was obtained from a questionnaire. The influence of parental smoking on relative leg length, controlled for age, sex, birth weight and the mother's education, as a proxy measure of socioeconomic status, and controlled for an interaction between sex and birth weight, was assessed by an analysis of covariance, where relative leg length was the dependent variable, smoking and sex were the independent variables, and birth weight as well as the mother's education were the covariates. Three separate analyses were run for the three models of smoking habits during pregnancy: the mother's smoking, the father's smoking and both parents' smoking. Only both parents' smoking showed a significant effect on relative leg length of offspring. It is probable that foetal hypoxia caused by carbon monoxide contained in smoke decelerated the growth of the long bones of foetuses.

The risk for falls in older people in the context of objective functional studies

Falls may occur in each ontogenesis phase, but they become more frequent in the elderly and lead to serious health consequences. Dynamic changes in senior citizens’ environment and lifestyle makes studies of risk for falls necessary. To determine the relationship between the risk for falls and the objective functional and structural examination in the elderly living in Poland. The research consisted of 196 females and 61 males aged 60-88 recruited from health clinics, senior citizen centers and Universities of the Third Age between 2009-2012. Following parameters were collected: functional physical tests “30 second Chair Stand Test” and Timed Up and Go Test”, the flexor muscles and knee extensors force, the bone mineral density was measured in distal radius of the forearm with the EXA - 3000, the total risk for fall assessed by 5 tests by abbreviated version of Fallscreen test. Multiple linear regression and linear correlation were used for assessment of relationship with total estimated risk for fall and other parameters. The subjects displayed significant dimorphic differences within the range of the functional parameters and bone mineral density to the advantage of males. Only in women results revealed a significant link between the risk for falls and the dynamic balance, as well as the maximum quadricep muscle force equal. Strength of the lower limb muscles seems to be critical for decreasing the risk for fall. Special programs for strengthening this part of the body for older people should be elaborate.

Endoscopic treatment of gastric varices bleeding with the use of n-butyl-2 cyanoacrylate

INTRODUCTION

Oesophageal varices and gastric varices are naturally-formed, pathological portosystemic shunts that occur in patients with portal hypertension. Gastric varices are responsible for about 10% of variceal bleeding; however, they are also the cause of massive haemorrhage, often with dramatic progress.

AIM

To assess the results of endoscopic treatment of gastrointestinal bleeding from oesophageal and gastric varices using tissue glue Histoacryl.

MATERIAL AND METHODS

From January 2013 to May 2015 170 patients underwent a total of 244 obliterations with the administration of tissue glue due to gastroesophageal varices. We analysed 35 patients who received urgent endoscopic intervention due to life-threatening gastric variceal bleeding.

RESULTS

Thirty-five patients underwent 47 endoscopic procedures of haemorrhage management. Immediate haemostasis was achieved in 32 (91.4%) patients. In 3 (8.6%) cases endoscopy failed. In 2 patients a Linton tube was applied before secondary endoscopy. A single trans jugular portosystemic shunt (TIPS) was performed. Permanent haemostasis during the first endoscopy was achieved in 26 (74%) patients. Six (17%) patients presented recurrent bleeding 1-4 days following the initial treatment. Three patients had a splenic artery embolisation performed. One of the embolised patients required surgery, and a splenectomy was carried out.

CONCLUSIONS

If this kind of therapy is unavailable at the time, it is advised that one of the conventional methods of controlling bleeding is used, introducing basic life support and transporting the patient to a specialist centre with adequate endoscopic facilities, radiological possibilities of endovascular intervention, and surgical treatment of liver transplantation.

Endoscopic Treatment of Early Biliary Complications in Liver Transplant Recipients

BACKGROUND

The most common complications following liver transplantation (LTx) concern the biliary ducts. Potential early complications are biliary leaks and anastomotic strictures of the bile duct. The aim of this study was to evaluate the efficacy of endoscopic treatment of early biliary complications in liver transplant recipients after end-to-end biliary anastomosis.

MATERIAL AND METHODS

From January 2011 to December 2013, 475 patients underwent LTx at our Department. There were 101 endoscopic procedures performed in total during this period, out of which 67 were related to biliary complications in 44 patients, while the remaining procedures were carried out due to gastrointestinal bleeding. We established a timeframe of up to 3 months postoperatively as the early biliary complication period. With the selected criteria we retrospectively analyzed medical records of 24 liver recipients who underwent endoscopic treatment due to early biliary complications. The outcome of endoscopic treatment was statistically analyzed and categorized as a technical and clinical success.

RESULTS

During this period there were 38 endoscopic procedures in the analyzed group of patients treated due to early biliary complications. The results were: successful balloon dilation alone was performed in 2 patients with no further need of treatment, implantation of plastic stents was performed initially in 13 patients, but 7 patients required further stenting with larger caliber plastic stents (PS). Self-expandable metal stents (SEMS) were initially placed in 7 patients during this period overall. One patient was treated due to hemobilia. In 1 case endoscopic retrograde cholangiopancreatography (ERCP) was unfeasible and the patient required surgical intervention. In 1 case a PS was exchanged for an SEMS. Six patients with satisfactory cholangiography images had the stent removed during the second ERCP.

CONCLUSIONS

In consideration of the stabilized rate of biliary complications following LTx, an advanced transplant center cannot function without an experienced endoscopist. For early biliary leaks and anastomotic strictures, ERCP is the primary treatment.

Age of onset of a normally timed pubertal growth spurt affects the final height of children

BACKGROUND

The exact nature of the relationship between the age of onset of puberty and final height in normally maturing children is controversial. Some authors have claimed that the age of pubertal onset does not affect final height, and others have claimed the opposite. We hypothesized that both height and the age of onset of the pubertal growth spurt (PGS) are correlated to final height.

METHODS

The height measurements of 335 children (162 girls) were analyzed in an observational retrospective study. The age and height at the onset of the PGS were computed from the equations of the Karlberg's infancy-childhood-puberty model.

RESULTS

A very low correlation was found between the age of onset of the PGS and final height. However, the correlation became very high when the parameter "height at onset of the PGS" was included in the regression analysis. The model was found reliable when tested on growth data of 60 Israeli children.

CONCLUSIONS

Final height is influenced by both height and the age of onset of the PGS in normal maturing children. A normal but early puberty exerts a negative effect on final height. A delayed PGS exerts a positive effect on final height.

Gall-Stone Ileus--Own Patients And Literature Review

Cholelithiasis is diagnosed in 10% of the population of the USA and Western Europe. A rare but serious complication of cholelithiasis is the obstruction of the digestive tract caused by a gall-stone (Bernard syndrome). It can add up to 1-4% of the mechanical obstructions of a small intestine among the general population but it can result in nonstriangulational mechanical obstructions of a small intestine in 25% cases among the patients over the age of 65. 5 patients have undergone an operation due to a small intestine gall-stone ileus in years 2011-2013 (within 27 months) in the General Surgery Ward of the Beskid Oncology Center - Municipal Hospital. In 4 patients simple enterotomy with a gall-stone extraction was performed. In the fifth patient enterolitotomy was conducted together with cholecystectomy and fistulotomy.

Groin hernia surgery in northern Ghana--humanitarian mission of Polish surgeons in Tamale

Availability of surgical care in Africa is severely limited. This is due to the lack of surgeons and a small number of public hospitals. Only 25 out of 100,000 patients with inguinal hernia undergo a surgical treatment. As many as 65% of inguinal hernia repairs are performed urgently because of incarceration. Among patients with incarceration who do not reach the hospital there is recorded as many as 87 deaths per 100 cases. In order to improve the availability of treatment of inguinal hernia in Africa, humanitarian medical missions involving surgeons from Europe are organized. During regular visits to selected centers in Africa, they also carry out intensified treatment of patients and training of the local staff. The aim of the study was to present the experience of Polish surgeons from the humanitarian medical mission in Tamale in northern Ghana undertaken in fall of 2014.

MATERIAL AND METHODS

Surgical repair was performed in 87 patients (74 men - 85% and 13 women - 15%) between the ages of 26 to 70 years (mean 52.8 years; SD 10.3), who underwent a total of 98 inguinal hernia repairs under local anesthesia.

RESULTS

Lichtenstein procedure was performed in 93 and Desarda technique in 5 patients. Patients reported the long-term presence of hernia symptoms - from one to 7 years (mean 3.4 years, SD 1.4). In most patients, hernia occurred more than 3 years earlier (61 patients; 70%). There were no intraoperative complications. All patients were discharged the next day after surgery. There was one wound infection in postoperative period which required mesh explantation.

CONCLUSIONS

Inguinal hernia commonly found in Ghana is a major issue for the inefficient health care system. Humanitarian medical missions can help to improve the treatment results, as long as they are carried out periodically and allow for training of local personnel. Scarce equipment of medical facilities in Ghana is not a significant difficulty in performing the Lichtenstein repair under the local anesthesia.

Laparoscopy-assisted total gastrectomy with D2 lymphadenectomy and Roux-en-Y reconstruction--case report

We report a case of patient with stage IIIb gastric cancer qualified for laparoscopy-assisted gastrectomy and our first impressions about this procedure. Total gastrectomy with complete omentectomy and extended lymphadenectomy (D2) was performed laparoscopically. The intestinal continuity was restored in a Roux-en-Y mode extracorporeally through the abdominal access system. The orogastric tube with anvil of the circular stapler was transorally introduced into the esophagus. Subsequently, intracorporeal stapling esophagojejunostomy was performed. There were no complications after the operation and the patient was discharged in good shape. Oncological radicality was sufficient and patient has undergone chemotherapy treatment.

Acetaminophen (Paracetamol) induced acute liver failure - A social problem in an era of increasing tendency to self-treatment

INTRODUCTION

The widespread availability of medication without prescription, so-called over the counter (OTC), and the rapid development of health consciousness of Poles is associated with broad access to medical information in the mass media. This causes patients to recognize their own disease, cancel doctor's appointments, and begin self-treatment. This time and money-saving behavior, often signaled by pain, usually leads to the treatment of symptoms alone, without seeking the cause of the disease.The aim of the study was to present life-threatening paracetamol poisoning, and the treatment of acute liver failure.

MATERIAL AND METHODS

In 2002-2014, 35 patients were hospitalized due to acute paracetamol poisoning: 17 female and 18 male patients aged between 17-59 (mean 32.3 years). Patients were treated in the surgical intensive care unit, where their parameters of liver and renal function were continuously monitored. If there was no improvement in the liver function, patients underwent albumin dialysis with the Prometheus system and were qualified for liver transplantation (LTx).

RESULTS

26 patients were treated pharmacologically and 7 out of 9 patients who underwent LTx were dialyzed. Overall, 11 patients had 26 albumin dialysis in total; 4 patients died - 1 post-transplant and 3 pre-transplant.

CONCLUSIONS

Paracetamol is the cause of many poisonings resulting from the lack of public awareness about toxic interactions with alcohol, and suicide attempts. Acetaminophen-induced acute liver failure concerns a small percentage of patients but can be successfully treated with albumin dialysis, and in extreme cases by liver transplantation.

The optimal value of BMI for the lowest risk of osteoporosis in postmenopausal women aged 40-88 years

The aim of this paper is to establish the optimal values of the body mass index (BMI) which would indicate the most favourable preservation of the bone mineral density in postmenopausal women. The material consists of the data of 369 healthy women aged between 40 and 88 years (mean age 67.84, SD=6.70) inhabitants of Wrocław, which were followed up between 2001 and 2006. The absolute measure of bone mineral density (BMD) of the femoral neck was assessed using dual energy X-ray absorptiometry (DEXA), expressed in g/(100mm(2)) and was transformed to T-score values. According to the value of BMI, the women were divided into eight groups, the reference group with value between 18.0 and 21.9kg/m(2) and seven other groups beginning with the value 22.0 with a 2-point interval. Postmenopausal status was defined according to the occurrence of menstruation within the last 360 days. The women with osteopenia and osteoporosis were pooled together and comprised the risk group, whereas the other women comprised the normal group (T-score values above -1.0). The adjusted odds ratio showed the highest value for intervals between 24.0 and 25.9 units of BMI, and the lowest value for interval 26.0-27.9 units of BMI. The Youden index showed the lowest value in the 26.0-27.9BMI kg/m(2) interval. For our sample the optimal value of BMI, with the lowest risk of osteopenia and/or osteoporosis was the value of 26.9kg/m(2). A further increase of BMI does not result in a favourable effect on the bones, it rather intensifies negative phenomena in the body resulting in the onset of many diseases.

Life satisfaction and cardiovascular disease risk in Poland

INTRODUCTION

Cardiovascular disease is the most common cause of death. Life satisfaction is a predictor of morbidity and mortality, irrespectively of objective measures of health status. The aim of the study was to evaluate the relationship between life satisfaction (LS) and cardiovascular disease risk (CVD) assessed with the Framingham Risk Score (FRS) in Polish adults.

MATERIAL AND METHODS

Past, present and projected LS were estimated. The FRS reflecting 10-year CVD risk was calculated from health indices and lifestyle parameters. Relationships between LS and FRS were tested by two-way analysis of variance in 489 men and 591 women, 40-50 years of age.

RESULTS

Subjects with a reduction in LS over time had a higher FRS compared to peers with an improvement in LS. The relationship between current LS and FRS had a J-shape in men; FRS was lowest in men with an LS of 5-7 (average LS), slightly higher in men with an LS of 8-10 (highest LS), and highest in men with an LS of 1-4 (lowest LS). Among women, there was an inverse linear relationship between LS and FRS: the higher the LS, the lower FRS. There was a strong linear relationship between predicted LS and CVD risk. Highest risk was evident in subjects with low LS in whom low LS was predicted over the next five years.

CONCLUSIONS

Low LS (dissatisfaction) thus has a long-term negative effect on CVD risk in Polish adults of both sexes.