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EN
There is always a certain rate of recurrence after radical treatment for cancer and to get on it an early detection of disease set back is crucial.Material and methods. Medical data of patients operated on for primarily detected colorectal cancer in years 1993-2002 was retrospectively reviewed. Usefulness of follow-up means such as physical examination, or CEA and endoscopic surveillance was analyzed. All mentioned above were applied to scheduled follow-up (in 3, 6 and 12 month intervals following an operation and annually after that by the year 5).Results. Complete and reliable data was obtained from 340 out of 502 follow-up intended subjects (67.7%). Elevated CEA was the most frequent predictor of recurrence within non-symptomatic subjects meeting follow-up appointments (60%). The cancer set back diagnosed by means of either physical or endoscopic examinations was the case only in one out of five patients (20.75% and 18.87% respectively). Clinical onset of recurrence making patients meet an unscheduled appointment was found increasing relative risk of nothing-but-palliative option either for them with local set back, or meta-static spread. Relative risk of onset of meta-chronous colonic cancer was significantly higher in patients being affected by synchronous advanced adenoma at time of surgery compared to those with one-fold changes.Conclusions. CEA scheduled follow-up after treatment for colorectal cancer CRC seems adequate to provide a good outcome of treatment for recurrent tumors. CRC patients presenting with synchronous advanced adenomas at time of surgery are probably to be under more intensive endoscopic surveillance.
PL
Wstep: Celem pracy była ocena znaczenia stężenia antygenu karcynoembrionalnego i metalloproteinazy 2 w surowicy krwi i popłuczynach otrzewnowych w ocenie stopnia zaawansowania nowotworu i przeżyciem 5-letnim chorych na raka jelita grubego. Materiał i metody: Do badania włączono 80 chorych poddanych planowej operacji resekcyjnej z powodu raka jelita grubego. U chorych oznaczono stężenia CEA i MMP-2 w surowicy krwi przed operacją oraz w popłuczynach otrzewnowych na początku laparotomii. Wyniki: Oceniając cechę T stężenie CEA w surowicy i w popłuczynach było niższe w T2 niż w T3 i T4. Różnicę istotną statystycznie odnotowano pomiędzy stężeniem CEA-s i CEA-p w T2 i T4. Stężenie MMP2-s było wyższe w T3 niż w T2, stężenie MMP2-p było najniższe w T3, bez istotności statystycznej. W przypadku cechy N istotną różnicę wykazano pomiędzy stężeniami CEA-s w stopniu N0 i N1. Dla stężenia CEA-p istotna statystycznie różnica wystąpiła pomiędzy stężeniami w stopniach N0-N2 oraz N1-N2. Stężenie MMP2-s było najwyższe w N1, stężenie MMP2-p było najwyższe w T4, jednak bez istotności statystycznej. 5-letnie przeżycie w całej grupie chorych wyniosło 63,53%. Odnotowano istotne statystycznie różnice w stężeniu CEA-s i CEA-p pomiędzy grupami chorych, których przeżycie wyniosło do 5 lat lub było dłuższe. Wnioski: Stężenie CEA w popłuczynach otrzewnowych jest równie wartościowe jak ocena stężenia CEA w surowicy krwi i może służyć jako dodatkowy parametr w ocenie stopnia zaawansowania choroby nowotworowej. Stężenie CEA w popłuczynach otrzewnowych i w surowicy krwi ma związek z odsetkiem przeżyć 5-letnich i może mieć znaczenie jako dodatkowy czynnik prognostyczny. Przydatność oznaczania MMP-2 wymaga dalszych badań.
EN
Purpose: The aim of the study was to determine the significance of carcinoembryonic antigen and matrix metalloproteinase 2 peritoneal washes and serum concentration in patients suffering from colorectal cancer concerning tumor staging and 5-year survival rate in these patients. Methods: 80 patients who underwent curative surgery for colorectal cancer were included in the study. Preoperative serum and intraoperative peritoneal washes CEA and MMP-2 concentrations were measured. Results: Regarding tumor penetration, CEA-s and CEA-p concentrations were higher in subsequent stages from T2 to T4. Both CEA-s and CEA-p concentrations were lower in T2 compared to T3 and T4. Significant difference of CEA-s and CEA-p was noted between T2 and T4 stages. MMP-2-s concentration was higher in T3 compared to T2, the highest MMP-2-p concentration was in T4, with no statistical significance. Regarding nodular status, a significant difference of CEA-s was noted between N0 and N1. For CEA-p, significance was found between N0 and N2 as between N1 and N2. MMP-2-s concentration was the highest in N1, MMP-2-p concentration was the highest in T4, with no statistical significance. The 5-year survival rate for all patients was 63.53%. There were significant differences in CEA-s and CEA-p concentrations between patients with negative and positive 5-year survival. Conclusion: Intraoperative peritoneal washes concentration of CEA may potentially serve as an important factor for more precise colorectal cancer staging. CEA-p and CEA-s concentrations correlate with survival rate in patients suffering from colorectal cancer and can be useful as an additional prognostic factor. The usefulness of MMP-2 measurement still requires further studies.
EN
Finding the biomarker or biomarkers with high sensitivity and specificity in colorectal cancer, and thus a high diagnostic value will determine their clinical usefulness in clinical practice. An effective noninvasive blood test would be an ideal method to detect colorectal cancer. Discovered in 2007 a novel tumor marker CCSA-2 showes a promising results in patients with colorectal cancer.The aim of the study was the evaluation of diagnostic and clinical value of a novel marker - colon cancer specific antigen-2 (CCSA-2) in colorectal adenocarcinoma in comparison to carcinoembryonic antigen (CEA) in patients operated during the years 2008 to 2010 at Wrocław Medical University 1st Department and Clinic of General, Gastroenterological and Endocrinologic Surgery.Material and methods. The study was performed on 40 patients with colorectal cancer and 40 patients in control group consisted of healthy subjects who had colonoscopy examinations with negative results (no pathology in the colon was found). The obtained results were statistically analyzed using nonparametric tests - Mann Whitney U and Kruskal-Wallis and Spearman's rank correlation coefficients. To determine the clinical value of CCSA-2 and CEA in those groups, their sensitivity and specifity was evaluated using ROC analysis. This analysis determines the accuracy and diagnostic value of both tests.Results. There was a positive correlation between markers in patients with colorectal cancer and a statistically significant relationship according to which respondents with higher concentrations of CCSA-2 also have higher concentrations of CEA (R=0.754, p<0,001). Concentrations of tumor markers increase and correlate with the clinical progression of the disease. Accuracy of CCSA-2 test using ROC analysis showed a slightly lower measurement of antigen CCSA-2 as diagnostic value in colorectal cancer in comparison to measurement of antigen CEA (accuracy of tests: CCSA-2 - 52%, CEA - 60%).Conclusions. CCSA-2 as a single tumor marker has a low diagnostic value in colorectal cancer because of low sensitivity and specifity. The diagnostic value of novel marker is slightly lower than previously understood and accepted in clinical practice - CEA.
EN
Background: Diabetes mellitus is closely related to pancreas cancer. In this study we aimed to investigate the effect of hyperglycemia on tumor and inflammation markers, as well as pancreatic exocrine functions.Methods: A total of 98 consecutive diabetic patients with poor glycemic control, and 50 healthy controls were included in the study. We measured hsCRP, erythrocyte sedimentation rate (ESR), CA19-9, CEA, amylase and lipase in addition to routine biochemistry tests, before and after euglycemia was achieved.Results: Fasting blood glucose, HbA1c, CA19-9,CEA, hsCRP, ESR, triglycerides, AST, ALT, GGT, ALP, total cholesterol and LDL-C levels decreased significantly with the regulation of glycemic control. Amylase and lipase levels increased with the regulation of glycemic control. After glycemic control, CA19-9 and CEA levels were still higher, whereas amylase and lipase levels were still lower in the diabetic group compared with the control group. Basal HbA1c showed significant correlation with CA19-9, CEA, amylaseand lipase.Conclusions: We propose to repeat observations of tumor markers after hyperglycemia is resolved, in order to avoid unnecessary invasive tests. Our data also suggest that pancreatic exocrine function was improved with lowering blood glucose in a short period of time.
EN
The search for neuromarkers is a very promising way to improve psychiatric and psychological care. They are now considered to be an innovative diagnostic tool in psychiatry and neuropsychology, but more broadly in all human health sciences. The aim of our study was to find the neuromarker of anxiety in a patient who had experienced a Transient IschemicAttack (TIA) of the left brain hemisphere as a result of a critical stenosis of the Internal Carotid Artery (ICA) operated on byendarterectomy (CEA). We will present the case of a 54-year-old man,an architect, who experienced a Transient Ischemic Attack (TIA) of the left brain hemispherecaused by a critical stenosis of theInternal Carotid Artery (ICA) and was treated successfully with surgical endarterectomy (CEA). One year after the surgery itself, the patient developed severe postoperative anxiety, headaches, difficulty in sleepingas well as the inability to continue working in his profession. Strong anxiety was notedon the adapted 100-millimeter Visual Analogue Anxiety Scale (VAAS). The patient was assessed using the Human Brain Index (HBI) methodology (Kropotov 2009; 2016; 2017; Pąchalska, Kaczmarek&Kropotov 2014) which consisted of recording 19-channel EEG in resting state conditions, during the cued GO/NOGO task and comparing the parameters of EEG spectra and Event-Related Potentials (ERPs) with the normative and patient databases of the Human Brain Index(HBI). No signs of cognitive dysfunction was found, however an excessive Rolandic beta was observed. In line with the working hypothesis as to the presence of an anxiety neuromarker, the patient’s studies confirmed an increased P1 time wave in the left hemisphere of the brain in ERP in response to visual stimuli, i.e. an anxiety neuromarker. Following the detection of this neuromarkera specific anodic Transcranial Direct Current Stimulations (tDCS) pro- tocol was proposed (see: Kropotov 2016; Pąchalska, Kaczmarek & Kropotov 2020). Ten tDCS sessions were performed and the postoperativeanxiety was found to be resolved. The patient returned to work. The use of Human Brain Index (HBI) methodologyenabling the isolation of the Event Related Potentials (ERPs) patterns revealed the presence of a distinct anxietyneuromarker. Neurotherapy with the use of tDCS allowed the reduction of anxiety symptoms and the patient’s return to work. The above case study indicates the necessity to use new neurotechnologies in the diagnosis of mental diseases, with particular emphasis on postoperative anxiety. ------------------------------------------------------------------------------------------------------------------------------------
EN
The aim of the study was to evaluate the quality of life of a patient af- terendarterectomy (CEA) of the Internal Carotid Artery (ICA) following an Acute ischemic stroke (AIS) during COVID-19. A right-handed, 51-year-old patient, a visual artist, single, in good health and no chronic illnesses to date, became infected with SARS-CoV-2 and contracted COVID-19. The presence of SARS-CoV-2 virus was confirmed by a RT PCR antigen test. The patient was hospitalized, and required mechanical ventilation at an Intensive Care Unit (ICU) before an acute ischemic stroke (AIS) onset. Except for untreated hypertension, her medical history was unremarkable. Her blood pressure was 180/100 mm Hg; her pulse was 76 beats per minute and was regular. AIS from the left middle cerebral artery (MCA) has resulted primarily in damage to the left hemisphere, and secondary effects on the right side resulting in body weakness and mild anomic aphasia. Magnetic resonance imaging (MRI) confirmed stroke and detected brain tissue damaged by an AIS. It revealed hyperintense foci in the T2 and FLAIR sequences, 21 mm in size in the left hemisphere of the brain. In search of the cause of AIS, CT angiography was performed. It revealed a large (90%) ICA occlusion. The patient was admitted to the emergency room at the Vascular Surgery Clinic with an Endovascular Subunit. The revascularization procedure (CEA) was performed under general endotracheal anesthesia with the use of the protocol and techniques (elaborated at the Department of Vascular Surgery and Endovascular Procedures, The John Paul II Hospital in Krakow). The CEA procedure improved her general health: she regained the ability to name objects and her HRQOL also improved in her perception. The improvement achieved was statistically significant. She returned to painting and functions well in society. The patient’s perception of HRQoL measured by the SF-36 domains was better after the CEA: a significant improvement in self-reported overall health has occured. The HRQoL outcome measures may be valuable in future clinical trials of comparing different methods of treatment offered after AIS.
EN
SUMMARY The purpose of this study was to determine the quality of life of a patient with persistent complications of SARS-CoV-2 infection requiring urgens surgical intervention – endarterectomy with emergency angioplasty of an inflamed, bleeding Right Internal Carotid Artery (RICA) by direct access via Right Common Carotid Artery (RCCA), known as Transcarotid Artery Revascularization (TCAR). A patient in her 60s was infected with the SARS-CoV-2 virus and contracted COVID-19 in March 2022, as confirmed by RT PCR antigen test. The infection was followed by short- and long-term complications, many of which can be linked to COVID. These include significant weakness persisting for months after the illness, rapid weight loss of 25 kg, sleep disturbances, chronic fatigue, severe dizziness, onset of diabetes, decrease dimmunity with increased periodontal inflammation (including formation of a periapical abscess of a molar tooth) and secondary suppuration of the submandibular lymphnodes, one of which lying jacent to the right internal carotidartery (RICA). This accumulation of symptoms led the patient to seek medical and neuropsychological help. Test ingusing the Beck Depression Inventory (BDI) confirmed depression, with vegetative disorders being the most predominant. Eight months after undergoing COVID-19, the patient suffered a Transient Ischemic Attack (TIA). The accumulation of diseases (diabetes mellitus, stage III hypertension and TIA) had a dramatic impact on the patient's health, including life-threatening conditions.A vascular surgeon consulted the patient advised immediate surgical treatment: carotid endarterectomy. The urgency of the situation was exacerbated by bleeding during the operation from the operated, secondarily inflamed wall of the RICA (lying adjacent to the suppurated submandibular node). This prompted an emergency decision for an endovascular procedure: the implantation of a stent covered with water-proof material (peripheral stent graft). This was made by a direct access via puncture of the common carotid artery (RCCA) below the endarterectomy level (TCAR). The SF-36 questionnaire was chosen to measure health-related quality of life (HRQOL).The SF-36 results are presented in such a way that higher scores correspond to fewer complaints, indicating better health and higher quality of life. Before revascularization, the patient's HRQOL was found to be lower, which was related to the negative impact of long COVID, while after the procedure, the quality of life gradually improved in subsequent surveys. A significant difference was found in physical function, with a mean score of 66.0 (p<0.001) compared to a score of 94.9 (±9.4) for 100 age-matched health subjects. A similar result was found in the physical role (p < 0.001). The patient's overall quality of life score was 331.0 compared to a score of 578.0 (±111.9) for age-matched normal healthy people. Better quality of life in patients with long COVID is an important therapeutic goal that can be achieved through comprehensive, multispecialty treatment for both physical and psychological conditions.
EN
Hepatocellular carcinoma (HCC) is one of the deadliest primary cancers, with a 5-year survival rate of 10% or less. This study was undertaken to elucidate the underlying biochemical and molecular mechanisms in favor of N-nitrosodiethylamine-induced hepatocellular carcinoma. Furthermore, the aim of this work was extended to explore the efficacy of Ginkgo biloba leaves extract in deterioration of HCC in rats. In the current study, HCC group experienced significant downregulation of ING-3 gene expression and upregulation of Foxp-1 gene expression in liver. Treatment of HCC groups with Ginkgo biloba leaves extract resulted in upregulation of ING-3 and downregulation of Foxp-1 gene expression in liver. In addition, there was significant increase in serum alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA) and glypican-3 (GPC-3) levels in HCC group versus the negative control group. In contrast, the groups with HCC subjected to either high or low dose of Ginkgo biloba leaves extract elicited significant reduction (P<0.05) of AFP, CEA and GPC-3 in serum compared to the untreated HCC rats. Besides, histological examination of liver tissue sections of rats in HCC group revealed typical anaplasia. Interestingly, treatment with Ginkgo biloba leaves extract elicited marked improvement in the histological feature of liver tissue in HCC groups. In conclusion, this research indicated that the carcinogenic potency of N-nitrosodiethylamine targeted multiple systems on the cellular and molecular levels. In addition, the results of the current study shed light on the promising anticancer activity of Ginkgo biloba leaves extract in treatment of hepatocellular carcinoma induced chemically in the experimental model through its apoptotic and antiproliferative properties.
EN
Since the 1970s we are witnessing a continuing search for new markers that would assist in the treatment and follow- up of patients with malignant tumors. First reports on benefits of assessment of tumor markers authored by Goldman and Freedman date back to 1965. Discovery of the first carcinoembryonic antigen (CEA) initiate an era of search for substances, still insufficiently sensitive and specific as to be used to screen tumors, but increasingly helpful in the assessment of treatment effects. This paper discusses the role of tumor markers, increasingly often referred to as “classic” in the monitoring of tumors. We present an update on markers with the longest history in oncology practice, e.g. CEA and on the recently introduced marker TATI. Selection of markers was made based on their role in three basic processes taking place in tumor cells, i.e. proliferation, differentiation and apoptosis. We highlight novel and expanding fields of research – genomics and proteomics, which appear to be the future of oncology. They are extremely useful in the evaluation of molecular prognostic factors, enabling implementationof individually tailored targeted therapies in cancer patients. We discuss classic markers and the few known cancer- specific substances. To sum-up, we state that understanding of the role of more sensitive and more specific markers in oncology may contribute to a more personalized treatment and thus may improve the outcome in cancer patients.
PL
Od lat siedemdziesiątych XX wieku nieustannie poszukuje się nowych markerów, które mogą być pomocne w leczeniu i kontroli po jego ukończeniu u chorych na nowotwory złośliwe. Po raz pierwszy przydatność określania markerów nowotworowych opisali Goldman i Freedman w 1965 roku. Oznaczyli pierwszy marker CEA (karcynoembrionalny) i tak zapoczątkowali erę odkryć substancji o wciąż niezadowalającej czułości i swoistości, aby mogły być używane do skriningu chorób nowotworowych, lecz coraz bardziej przydatnych w ocenie efektu leczenia. W pracy opisano zastosowanie markerów nowotworowych coraz częściej określanych mianem klasycznych w procesie śledzenia chorób nowotworowych. Zaprezentowano najnowsze informacje o markerach najdłużej stosowanych w praktyce onkologicznej, na przykład CEA, jak również o nowo wykorzystywanym markerze TATI. Doboru markerów dokonano na podstawie ich udziału w trzech procesach toczących się w komórkach nowotworowych: proliferacji, różnicowaniu i obumieraniu komórek. Zwrócono uwagę na rozwijające się nowe dyscypliny nauki – genomikę i proteomikę, stanowiące przyszłość onkologii. Są one niezwykle pomocne w określeniu molekularnych czynników predykcyjnych umożliwiających stosowanie leczenia celowanego u chorych na nowotwory złośliwe. Opisano markery klasyczne, a także nieliczne markery molekularne występujące w różnych nowotworach. W podsumowaniu stwierdzono, że poznanie natury markerów o znaczącej czułości i swoistości w chorobach nowotworowych może wpłynąć na personalizację leczenia i tą drogą na poprawę wyleczeń chorych na nowotwory złośliwe.
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