Przegla̧d lekarski (Przegl Lek )


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Publications in this journal

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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.
  • 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: 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: 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: 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: 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.
  • Przegla̧d lekarski 01/2014; 71(1):48-51.
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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: 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.
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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: Since 2001 a number of cases of mushroom poisoning with concomitant rhabdomyolysis have been described. Among the edible mushrooms growing in Europe, these reports concerned only Tricholoma equestre. The results of animal studies suggest that rhabdomyolysis could be a consequence of consumption of other edible fungi, and its occurrence depends on the amount of ingested mushrooms and individual sensitivity. To the best of our knowledge, this is the first report of rhabdomyolysis associated with the consumption of edible mushrooms from Leccinum and Boletus species. A 57-years old man was admitted to the hospital due to severe pain and weakness of thigh muscles with a high serum creatine kinase activity -3811 U/L. Within two days before hospitalization he consumed repeatedly large quantities of stewed Leccinum and Boletus mushrooms. Clinical signs of toxicity and biochemical changes subsided after several days of hospitalization. Rhabdomyolysis after ingestion of a large amount of mushrooms can be an unspecific symptom, unrelated to fungi species.
    Przegla̧d lekarski 01/2013; 70(8):684-6.
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    ABSTRACT: Article presents a case of a 71-year old woman with pulmonary right upper venous drainage into the superior vena cava and with coexistence sinus venous type Atrial Septal Defect (ASD) which was revealed as interesting finding in multislices computed tomography angiography during estimation of coronary arteries.
    Przegla̧d lekarski 01/2013; 70(5):353-5.
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    ABSTRACT: There are 12 centers of acute poisoning treatment and 9 round the clock toxicological laboratories. Most of the laboratories access evidence of activity run by National Clinical Toxicology Consultant. The paper presents actual status of medical toxicology laboratories in Poland and summarizes activity of the laboratories in the year 2012. In 2012 toxicological laboratories reported 113,719 assays. There were diagnosed 63.8% men and 34.8% women. The toxicological laboratories determine most substances and markers of exposition to chemical compounds important for diagnosis and treatment of acute poisonings (i.e. ethanol, methanol, ethylene glycol, acetaminophen, salicylates, anticonvulsants, carboxyhemoglobin, methemoglobin). There is not possible to determine heavy metals, all medicines and "designed" drugs of abuse in all laboratories. Limited access to reference methods, that enable to confirm results obtained by screening methods (immunological cassette and strip tests) is also a problem.
    Przegla̧d lekarski 01/2013; 70(8):490-9.
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    ABSTRACT: Previous studies have shown that tachykinins, the largest family of neuropeptides, affect the development of mucosal damage in the stomach and colon. The aim of the study was to assess the influence of tachykinins receptors antagonists on the development of the mucosa injury in the proximal and distal jejunum. Mucosal damage was induced by administration of non-steroidal anti inflammatory drugs (NSAIDs), indomethacin, celecoxib or combination of indomethacin plus celecoxib given intragastrically. NK-1 receptor antagonist (SR 140333), NK-2 receptor antagonist (SR 48968) and NK-3 receptor antagonist (SR 142801) were administered intraperitoneally twice, 30 min before treatment with NSAID and again 24 h later, 30 min before the end of the experiment. Administration of indomethacin, a relatively selective inhibitor for cyclooxygenase-1 (COX-1), induced mucosal lesions in the jejunum. Lesions area in the distal jejunum was 8-fold bigger than in the proximal jejunum. This effect was associated with a significant reduction in mucosal blood flow and an increase in mucosal concentration of pro-inflammatory interleukin-1beta (IL-1beta). Celecoxib, selective inhibitor for COX-2 failed to induce mucosal lesions and did not affect the mucosal blood flow and IL-1beta concentration in the proximal and distal jejunum. In rats treated with a combination of indomethacin plus celecoxib, ulcers reached maximal area. This effect was associated with the highest concentration of mucosal IL-1beta and maximal reduction in mucosal blood flow. Administration of NK-1 receptor antagonist, SR 140333 reduced jejunal damage induced by indomethacin given alone or in combination with celecoxib. This effect was associated with significant reduction in mucosal concentration of IL-1beta. Effect of SR 140333 on mucosal blood flow was statistically insignificant. Neither NK-2 nor NK-3 receptor inhibitor affected mucosal blood flow, IL-1beta concentration area of NSAIDs-induced mucosal damage in the jejunum. Blockade of NK-1 receptor protects the jejunum against NSAIDs-induced mucosal injury and reduces local inflammation. This observation indicates the involvement of endogenous tachykinins in deleterious effects of NSAID.
    Przegla̧d lekarski 01/2013; 70(2):48-52.
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    ABSTRACT: The Polish Physician's and Dentist's Profession Act and Polish Pharmaceutical Law oblige physicians to prescribing drugs strictly in line with the official indications listed in the Summaries of Product Characteristic (SPC). Prescriptions beyond SPC ('off-label') may be interpreted as 'medical experiments' with legal and financial liability resting solely with the doctor, the reimbursement is also denied. The aim of the study was to analyze discrepancies between up-to-date expert guidelines for treating atopic eczema (AE), indications listed in SPC, reimbursement policy, and scientific evidence for the efficacy of recommended drugs. Expert recommendations for the treatment of AE were confronted with SPC of recommended drugs and their reimbursement scheme. A systematic review of clinical trials was carried out, with their quality assessed using the GRADE tool. Among drugs recommended by experts for the treatment of AE, 484 medicinal products were licensed for use in Poland, including 89 with official indication for AE. Of these, clinical trials confirmed efficacy of active components of 36 topical or systemic calcineurin inhibitors and 19 topical glucocorticoid preparations. Thirty preparations for AE were reimbursed, including 19 recommended by experts and confirmed as effective. Further 75 products with active substances both recommended and effective were licensed for use in Poland, but not for AE. We conclude that regarding pharmacotherapy of atopic eczema, there are considerable discrepancies between expert recommendations, scientific evidence for the effectiveness of recommended drugs, and the acceptable uses of the drugs as determined by the Summaries of Product Characteristics (SPC) that are in force in Poland.
    Przegla̧d lekarski 01/2013; 70(12):1021-6.
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    ABSTRACT: The classic role of vitamin D is its effect on calcium and phosphate homeostasis. The subject of interest in recent years has been its non-calcemic impact on neoplastic processes and the immune system. The aim of the study was to assess 25(OH)D3 concentrations in patients treated for papillary thyroid carcinoma (PTC) and Hashimoto's thyroiditis (HT). The study included 80 patients aged 19-83 years (average age 52.96 years) treated between 2000-2011 in Swietokrzyskie Centrum Onkologii. The analysis was conducted in two groups of patients: a PTC group of 40 women aged 19 to 83 years (average age 50.40 years) and a HT group of 40 women aged 30 to 75 years (average age 55.73 years). The group of PTC patients was further divided into two subgroups: 19 patients with micro. carcinoma (T1a) and 21 patients with a higher grade of cancer (>T1a). A group of patients with HT comprised women treated with subsitutive doses of L-thyroxine for hypothyroidism. The serum concentration of 25(OH)D3 was compared in both groups: PTC vs. HT. Among patients with PTC serum 25(OH)D3 was analysed depending on the concentration of TSH: TSH< or = 0.1 microlU/ml vs. TSH> 0.1 microlU/ml, and depending on the stage of cancer: Tla vs.> T1a. There were no differences in the prevalence of hypovitaminosis and vitamin D deficiency in both groups (65% of patients with PTC vs. 62.5% with HT). In the PTC group no statistically significant differences in serum 25(OH)3, depending on the con. centration of TSH and cancer clinical stage, were found. This study showed no difference in concentrations of 25(OH)D3 in patients with papillary thyroid cancer and Hashimoto's thy. roiditis. Patients with PTC showed no relationship between serum 25(OH)D3 and clinical stage of the disease or TSH.level.
    Przegla̧d lekarski 01/2013; 70(11):920-5.
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    ABSTRACT: Homocysteine (Hcy) has recently become the focus of interest in the research on Parkinson's disease (PD) and other neurodegenarative disorders. Chronic treatment with levodopa (LD), considered the standard treatment for PD, leads to an increase in homocysteine concentration in serum and cerebro-spinal fluid. Independently from this effect, homocysteine is also regarded as a marker of neurodegenerative disorders. Main interest was focused on hyperhomocysteinemia (hHcy) as the potential risk factor for atheromatosis. Subsequently, its role in neuropsychiatric diseases, e.g. depression, mild cognitive impairment and dementia was investigated. The potential pathogenic role of Hcy in peripheral neuropathy in patients with PD that are treated with LD is an interesting hypothesis but the literature is scarce. Confirmation of this association may lead to introduction of preventive therapies, e.g. administration of vitamin B and inhibitors of catechol-O-methyl transferase (COMT) that may decrease the Hcy blood concentrations.
    Przegla̧d lekarski 01/2013; 70(7):443-7.

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