Przegla̧d lekarski (Przegl Lek )

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ISSN 0033-2240
OCLC 320522930
Material type Periodical
Document type Journal / Magazine / Newspaper

Publications in this journal

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    ABSTRACT: Introduction Falls are one of the most devastating health problems of elderly people. The identification of causes of falls helps to establish proper prevention strategies. Material and method The study was based on a group of community-dwelling, independent women aged over 50 years. The frequency of falls was calculated on the basis of a retrospective analysis of 1326 cases. 100 women were chosen for a telephone questionnaire to identify causes and consequences of falls. The average age was 63.9 (SD 8.6) and the average BMI was 27.6 (SD 5.4). Results Approximately 31% of 1326 women reported at least one fall a year. In the year preceding the questionnaire 62% of the participants reported one fall, 26% - two falls, 8% - three falls and 5% - four and more falls. In the surveyed group of 100 women 72% of falls occurred outdoors, which is 2.5 times more often than at home (28%). 68% of falls occurred between 12 pm and 6 pm. Summer is the season of the highest occurrence of falls (37%). In winter, the frequency of outdoor falls increases, whereas during summer the frequency of falls happening in and outdoors does not differ. The most frequent cause of falls, both in and outdoors, was slipping. Other important risk factors include: hypnotic drugs, walking impairments, balance deficit, vertigo, analgesics. Most of the falls had various intrinsic and extrinsic causes. Key points: We found that 30% of women aged over 50 years falls at least once a year. Both at home and outside falls resulted from slipping. For almost 80% of falls as a consequence of an injury. The majority of falls had intrinsic and extrinsic origins.
    Przegla̧d lekarski 10/2014; 71(10):516-519.
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    ABSTRACT: Postural orthostatic tachycardia syndrome (POTS) is one of the most common presentation of orthostatic intolerance. The syndrome is described as a multifactorial affliction. Main symptoms consist of persistent orthostatic tachycardia (heart rate increase at least 30 beats/min, lasting at least 10 min after assumic vertical position) with high noradrenalin serum concentration (measured in stand-up position). Additionally patients with POTS tend to have lover total blood volume. POTS is generally classified into dysatonomia disorders Symptoms in patients affected with POTS are chronic. The syndrome occurs predominantly in young women (approximately 80%). Due to complexity and variable intensity of symptoms POTS can severely impair daily activity and quality of life in otherwise healthy people. The correct diagnosis and identification of potential pathophysiological mechanisms of POTS is necessary before treatment administration. Adequate therapy can significantly reduce symptoms giving the patients a chance for a normal life.
    Przegla̧d lekarski 08/2014; 71(8):450-453.
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    ABSTRACT: This case report concerns a 68 year old male with, type 2 diabetes, stage 3 hypertension, hypercholesterolemia, myocardial infarction (MI) 20 years ago. He was admitted to the catheterization laboratory with suspected acute inferior wall MI. Angiography of pulmonary arteries revealed massive thrombosis.
    Przegla̧d lekarski 08/2014; 71(7):407-409.
  • Przegla̧d lekarski 01/2014; 71(1):52-6.
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    ABSTRACT: Parkinson's disease (PD) is a degenerative disease of the central nervous system, of which patomechanizm entirely is not clear. In the picture neuropathologically there is observed degeneration and loss of dopaminergic neurons, but also noradrenergic, serotonergic and cholinergic neurons in patients with PD. It is believed, that causes of PD are both environmental and genetic factors, associated mainly with mutations in the SNCA and PRKN genes, which may lead to changes in the structure of proteins such as alpha-synuclein (ASN) and Parkin. In neurons, disorders of the protein structure can lead to its aggregation and formation of soluble oligomers and insoluble filaments in the form of Lewy bodies and Lewy neuritis. In PD aggregation of ASN can be modulated by many factors like: oxidative stress, other neuronal proteins, Parkin, catecholamines especially dopamine, and mutations of SNCA gene. It also appears that some impact on the aggregation of ASN may have destabilizing factors of ASN tetramers. That, does ASN may become a new point for pharmacotherapy in PD.
    Przegla̧d lekarski 01/2014; 71(1):26-32.
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    ABSTRACT: Intraoperative iPTH assay (IOPTH) is often used during minimally invasive parathyroidectomy (MIP) to predict operative success. The aim of this study was to evaluate diagnostic accuracy of IOPTH during MIP with respect to few prognostic criteria most commonly used. A retrospective study of 455 patients with sporadic primary hyperparathyroidism undergoing MIP with IOPTH at our institution between 2003 and 2012 was undertaken. Diagnostic accuracy of few prognostic criteria most commonly used was done including Halle, Miami, Rome and Vienna criteria. Results of IOPTH were compared to outcomes of MIP in 6-months follow-up after surgery (serum calcium and iPTH levels). Both ROC (Receiver Operating Characteristics) curve and error matrix analysis were used for accuracy assessment of IOPTH prognostic criteria. Based on this method the following accuracy parameters were calculated for each IOPTH criterion separately: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy. The following diagnostic accuracy parameters of IOPTH were found for each of the tested criteria (sensitivity, specificity, PPV, NPV, accuracy), respectively: for Halle criterion 63.2%, 100.0%, 100.0%, 12.6%, 65.1%; for Miami criterion 97.7%, 96.4%, 99.8%, 73.0%, 97.6%; for Rome criterion 84.4%, 100.0%, 100.0%, 27.2%, 85.3%; for Vienna criterion 93.7%, 92.3%, 99.5%, 47.1%, 93.6%. Miami criterion of IOPTH is the most accurate in prognostication of postoperative serum calcium levels after MIP. Use of other criteria may involve a higher risk of false negative results and unnecessary conversion to more extensive neck dissection in search for non-existent hyperfunctioning parathyroid tissue.
    Przegla̧d lekarski 01/2014; 71(1):14-8.
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    ABSTRACT: CyberKnife based radiosurgery is increasingly becoming the common treatment modality used. The high precision and tumor tracking of the CyberKnife makes it a useful tool in gynecological oncology. The aim of this study was a preliminary evaluation of CyberKnife based radiosurgery effectiveness as a treatment of patients with gynecological malignancies metastases. 33 cases of gynecological malignancies metastases (19 patients) treated using CyberKnife (14--endometrium cancer, 12--ovary cancer, 7--cervix cancer; 25 adenocarcinomas, 7 SCC and 1 folliculoma). Between June 2011 and July 2013 we irradiated 16 lymph nodes metastases, 15 liver metastases, 1 bone and 1 mesentery metastasis using a fraction dose of from 6 Gy to 15 Gy (median 12) up to the total dose varied from 8 Gy to 45 Gy (delivered in 1-3 fractions). 21 cases underwent follow up. We analyzed tumor size changes and calculated the percentage of complete regressions and local control (LC) after 6 months. The median of tumor size (mean of three diameters) decreased from 1.6 cm before the treatment to 1.1 cm 6 months later. In the controlled group (21 cases) a 24% of total regressions were noted. 6 month LC was 88% (88% for lymph nodes metastases and 86% for liver metastases). The obtained results permit us to form the conclusion that CyberKnife based radiosurgery is an effective and safe treatment for patients with gynecological malignancies metastases.
    Przegla̧d lekarski 01/2014; 71(1):5-9.
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    ABSTRACT: Hyperhomocysteinemia seems to be a common phenomenon in both patients with ulcerative colitis and Crohn's disease. Many factors including deficiencies of cobalamin, folate and pyridoxine, smoking habits, alcohol and coffee intake, some medications and age may predispose subjects to hyperhomocysteinemia. The study aimed to evaluate homocysteine levels in an inflammatory bowel disease cohort as dependent of life style and disease activity.
    Przegla̧d lekarski 01/2014; 71(4):189-92.
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    ABSTRACT: The parathyroid glands, located near or within the posterior surface of the thyroid gland and secreting parathyroid hormone, are essential organs for the regulation of calcium and phosphate metabolism. As they are necessary to sustain life and maintain homeostasis, undetected or misdiagnosed parathyroid disorders may pose a significant threat to health outcomes, as their presence may increase morbidity and mortality in affected individuals. The clinical picture of some disorders associated with abnormal parathyroid hormone secretion and receptor action is sometimes complicated by coexisting abnormalities, and in these cases establishing the correct diagnosis is challenging. The remarkable progress of recent years in the area of hormonal assessment, imaging procedures and molecular biology, has resulted in a great improvement in the identification, differentiation and treatment of various parathyroid disorders and has made it possible to identify several new clinical entities. In this paper, we discuss the present state-of-art on the etiopathogenesis, clinical manifestations, diagnosis and treatment of chosen rare abnormalities of parathyroid gland function and parathyroid hormone receptor action.
    Przegla̧d lekarski 01/2014; 71(1):36-47.
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    ABSTRACT: Non melanoma skin cancers (NMSC) represent a major challenge within the ever growing group of different organs recipients. The aim of the study was to evaluate risk factors influencing on frequency appearance of NMSC in patients after kidney transplantation. The clinical dermatological examination was performed in 486 patients after kidney transplantation consisted of 296 man (60.9%) and 190 woman (30.1%) in the mean age 46.1 +/- 13.1 (18-74 years) with median time after transplantation 74.3 +/- 52.1 months. Most of them (80.7%) before transplantation were treated by maintenance hemodialysis. Patients after kidney transplantation were checked by dermatologist for all skin abnormalities based on iniciated skin cancers screening program. All discovered abnormalities were described, their type, size, localization and results of histopathological examination were collected. The obtained results were analyzed based on t-Student's, Mann-Whitney's, chi-square and Fisher tests. Out of 486 studied patients, 53 NMSC were diagnosed in 25 kidney recipients including 39 basal cell carcinoma (BCC), 13 squamous cell carcinoma (SCC) and 1 Bowen's disease. The proportion of BCC to SCC was 2.79. NMSC occurred more often on sun skin exposure area, especially on the face. Almost all (96.2%) of the cancers were diagnosed in patients older than 50 years of age. Patients with NMSC comparing with those without were significantly older (52.8 +/- 7.8 vs. 41.0 +/- 7.8; p < 0.0001), have longer post-transplant period and have more frequent positive anamnesis of this cancer. There was no significant relationship between NMSC appearance and sex, cause of kidney failure, HLA mismatch, blood group as well as Rh factor. Conclusions: Older age of patients while transplantation, longer time of immunosuppressive therapy and previous NMSC are independent predictors of new skin cancers appearance.
    Przegla̧d lekarski 01/2014; 71(1):19-25.
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    ABSTRACT: Dignity is innate value of human. In perspective of human dignity the health protection of patients is the essence of medical deontology, duty of love, which is taking by doctor and nurse is express by practice of profession, which does not lose human features. It is important, that is impossible to enjoin love, because love is not an order, it is open for other's needs. By virtue of this elderly cannot be treated like things in economic system of hospital, but through love "we should enable the elderly to grow in the conventional wisdom gathered by the entire life". Pope Benedict XVI notices that, every work, competence is the most important thing. Due to it, medicine extend respect for body human and the law, which rules it, furthermore recognize human life as sign of unexplored secret.
    Przegla̧d lekarski 01/2014; 71(1):57-60.
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    ABSTRACT: Blood loss due to diagnostic phlebotomy jest a very serious problem, especially for newborn, infants and critically ill patients on intensive care units. Although single blood loss can be easily tolerated in adults, in small babies and in patients who are frequently monitored based on laboratory tests iatrogenic anaemia can occur. To evaluate the blood volume drawn for routine biochemistry tests in relation to patient age and the number of parameters requested. Blood volume drawn for routine biochemistry measurements from patients hospitalized in University Children's Hospital (N = 2980, children age from one day to 18 years) and in University Hospital (N = 859, adults, aged > 1.8 years) in Cracow has been analyzed. Blood volume was calculated based on regular tube diameter and blood heights in the tube. In case of microvettes the blood volume was 0.2 ml. Statistical analysis has been performed by using PRISM 5.0. The statistical significance was set at p < 0.05. The mean values of blood volume were 3.02 +/- 0.92 ml and 4.12 +/- 0.68 ml in children and adults, respectively. Analyzing blood volume drawn in children using both microvettes and regular tubes, significant correlation between blood volume and patient age (p < 0.001) as well the number of requested parameters (p < 0.001). The latest relationship was true only for up to five parameters. However, analyzing the blood volume drawn into only into regular tubes blood volume was not related to patients age and number of laboratory tests requested. The proportion of microvettes used for blood collection was highest for newborns and infants, and in all cases where only one to three laboratory tests were requested. 1. All educational programs for nurses and doctors should include the information about current laboratory automation and methods miniaturization; 2) The amount of blood volume needed by laboratory for the requested number of tests should always be taken into account when diagnostic phlebotomy is necessary.
    Przegla̧d lekarski 01/2014; 71(1):10-3.
  • Przegla̧d lekarski 01/2014; 71(1):48-51.
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    ABSTRACT: Epidemiological data show that chronic kidney disease (CKD) is a serious social problem and nowadays is included amongst civilisation diseases. Knowing the relation between decrease in the number of nephrons and progressing kidney damage caused by it, we can treated each nephrectomy from medical reasons as a risk factor for development of CKD. The aim of this study was a retrospective analysis of clinical effects of nephrectomy, taking into account evaluation of a functional status of the sole kidney. The study covered 182 patients after nephrectomy in the period from 1979 to 2008. The morphological and functional status of the remaining kidney was evaluated using ultrasound scanning and on a basis of serum levels of creatinine, as well as the glomerular filtration rate. Occurrence of proteinuria and blood pressure values were also verified. The average creatinine serum levels increases after nephrectomy and is positively correlated with the age. The mean eGFR level is lower after nephrectomy and is correlated with kidney dimensions in the long-term control after nephrectomy, and with the age. The average systolic and diastolic blood pressure after nephrectomy in the long-term observation was higher as compare with values before procedure. Presence of protein in the urine of patients after nephrectomy correlated positively with increased blood pressure values. Nephrectomy constitute the risk factor of development of CKD and hypertension. Patients after nephrectomy needs systematic nephrological care to prevent CKD progression.
    Przegla̧d lekarski 01/2014; 71(1):1-4.