Gastrooesophageal reflux disease is the regurgitation of stomach contents into the esophagus, which causes troublesome symptoms or complications for the patient. Before starting the treatment, it is always necessary to objectively confirm gastroesophageal reflux disease, especially in correlation with ENT symptoms, as extra esophageal complications. In diagnostics, the "gold standard" is a 24-hour impedance-pH supplemented with endoscopy. Treatment without objective confirmation of the disease is not recommended, the more so that non-acid gas proximal reflux, detectable only in the MIIpH test, causes the greatest number of laryngological complications. It is important to confirm the coexistence of clinical symptoms of GERD with ESS. Considering the time of treating the disease and its consequences, it is worthwhile to be cautious and careful with the diagnosis of the disease, and the treatment should be carried out for a long time in relation to the recommendation, preferably in cooperation with an ENT specialist and gastroenterologist. The greatest therapeutic effectiveness is achieved by combining PPI with itopride while maintaining the appropriate doses of drugs and observing a sufficiently long duration of treatment, while maintaining the correct dose reduction and drug discontinuation regimen. In case of failure of pharmacological treatment, antireflux surgery should be take into consideration.
Solid pseudopapillary tumor (SPT) is a rare pancreatic tumor with low malignancy, constituting 1-2% of exocrine pancreatic tumors, occurring mostly in young women. SPT, despite the achievement of large size gives scant clinical symptoms. The authors present the case of 39-year-old woman with SPT, diagnosed at intraoperative biopsy. The aim of this study is to describe the clinicopathological feature, diagnosis and surgical treatment of SPT.
Dysphagia is an underestimated health problem. At the same time, it is a potentially life-threatening condition. Dysphagia in young adults is rare and thus it is rarely discussed in the literature. Vascular anomalies are much less frequent causes of dysphagia than structural pathologies of the digestive system, iatrogenic lesions or neurological causes. This paper presents a case of a 21-year-old woman with escalating dysphagia in the course of a congenital vascular anomaly in the form of a right-sided aortic arch with retroesophageal left subclavian artery (left arteria lusoria) and compression. The paper highlights delayed symptomatology of the congenital defect, reasons behind the long-lasting diagnostic process, and the role of the laryngological – phoniatric examination in order to exclude oral and pharyngeal causes. The differential diagnostics and treatment options are discussed thereinafter.
Multiple endocrine neoplasia type 1 (MEN1) syndrome is an autosomal dominant hereditary disorder characterised by coexistence of pancreatic neuroendocrine tumours (pNETs) with parathyroid and pituitary tumours. PNETs, including mostly non-functioning tumours, gastrinoma and insulinoma, occur in nearly 95% of MEN1 patients and account for over 50% of disorder-related mortality. Therefore, early initiation of screening for pNET using biochemical and imaging tests as well as appropriate surgical and systemic treatment are of particular importance for this group of patients. Currently, there are no clearly defined guidelines which determine the optimal methods for detection and treatment of pNET in MEN1. Caution should be exercised when applying the guidelines designed for patients with sporadic pNET to MEN1 patients as the clinical course of the disorder is slightly different, involving multifocality of lesions and younger age of patients at onset. This paper discusses the distinctive features and challenges in diagnosing and treating pNETs in MEN1 patients.
Gastroenteropancreatic neuroendocrine tumors (GEP NET) represent heterogenous group of very rare neoplasms. Nevertheless, these tumors have been increasingly diagnosed recently. Authors present own experience with surgical treatment of gastrointestinal neuroendocrine tumors.The aim of the study was to analyse retrospectively own material of patients with gastrointestinal neuroendocrine tumors treated surgically in the Department of General and Transplant Surgery of Medical University in Łódź.Material and methods. The analysis included all patients with neuroendocrine tumors surgically treated from January 2007 to June 2009 in the Department of General and Transplant Surgery of Medical University in Łódź. The clinical patients data were obtained from medical histories, operative protocols and outcomes of final histopathological examinations. Analyzed data were as follows: age, gender, type and localization of tumor, clinical signs, results of preoperative tests and type of surgical procedure.Results. Analysis revealed that 17 patients were operated on for gastrointestinal neuroendocrine tumors between years 2007-2009 in the Department of General and Transplant Surgery. Foregut tumors (5 gastric neuroendocrine tumors and 4 pancreatic insulinomas), midgut tumors (1 neuroendocrine cancer of ascending colon, 3 hepatic neuroendocrine cancers metastases, 2 primary hepatic neuroendocrine cancers, 1 gall bladder neuroendocrine cancer) and hindgut tumors (neuroendocrine cancer of rectum) were diagnosed in nine cases (53%), in seven cases (41%) and in one case (5%), respectively. Wide range of surgeries were performed in the Department, as follows: in 2 cases right hemihepatectomy, in 3 cases extended right hemihepatectomy, in 1 case left hemihepatectomy, in 4 cases pancreatic tumor enucleation, in 2 cases gastric resection, in 3 cases gastrectomy, in 1 case right hemicolectomy and in 1 case anterior resection of the rectum. The vast majority (11/17 patients; 64%) of tumors were poorly-differentiated neuroencorine carcinomas with high grade of histological malignancy. In one case coincidence of insulinoma and nesidioblastosis was confirmed. One patient suffered from signs of neuroglycopenia with loss of consciousness and convulsion preoperatively, incorrectly diagnosed as epilepsy.Conclusions. Treatment of patients with gastrointestinal tumors is complex process and most commonly require close cooperation of various proffesional clinicians. Since asymptomatic course of disease and late stage of tumor advancement at diagnosis, technically difficult operations are often essential. Thus, surgeon who perform operations of patients with neuroendocrine tumors should be well experienced in carring out extensive surgical procedures.
This article is a review of literature and a summary of the current guidelines in the diagnosis of hypertrophic vocal folds lesions suspected of malignancy. It gives a detailed overview both of initial diagnosis, as well as the methods of in-depth intraoperative diagnostics and proposals for careful evaluation during post-treatment follow-up examinations.
Introduction. The aim of this work was to assess the value of impedance audiometry in the differential diagnostics of hearing disorders, especially in patients suffering from tinnitus. Material and methods. The analysis dealt with results of the audiological tests in 198 patients (116 female and 82 male), hospitalised in 2007 due to their hearing deterioration, tinnitus or sudden deafness. The conducted audiological tests covered threshold and suprathreshold pure tone audiometry, speech audiometry, BERA and impedance audiometry. Results of the studies. Women (58.5%) and people over 50 years old (58.6%) constituted the majority of the patients. In 166 (83.8%) patients the conducted tests via impedance audiometry did not prove any deviations from the normal condition, the lesions referred to both ears in 32 (16.9%) patients and one ear in 17 (8.5%) patients. An incorrect tympanogram was found in 23 people, including type As in 11, type Ad in 2, type B in 4 and type C in 6 subjects. Low values of acoustic receptivity of the middle ear were noted in 20 ears, whereas high values in 11 ears. In 3 ears we found low values of the gradient (below 0.3), high values – in 11 ears. The middle ear pressure between –170 and –350 daPa was noticed in 20 ears, and positive values, above +50 daPa up to +75 daPa, in 3 ears. Disorders in the stapedial refl ex registration were observed in 38 (19.1%) patients. The assessment of the conducted subjective and objective audiological examinations allowed to recognise bilateral perceptive hearing injuries in 139 patients, including 49(25,9%) of cochlear origin with OWG, in further 70 patients the hearing loss referred to higher frequencies and was rather slight. Conclusions. The own experiences indicated that the impedance audiometry constitutes the integral part of contemporary audiological diagnostics and still remains an objective method facilitating quick, non-invasive evaluation of the functions of particular elements in the middle ear.
Pheochromocytomas are rare tumors arising from the adrenal medulla. The diagnosis of malignancy remains a dogma between surgeon, pathologist and oncologist. We present a case of voluminous pheochromocytoma in a 53-year-old female patient, suspect of malignancy in the pathologic examination, while emphasizing the importance of the clinical and radiological long-term monitoring.
Diagnosis is crucial in decision-making when treating a patient with shoulder pain. Ultrasound is also very important in the diagnostic and therapeutic pathway, especially when surgery is being considered. This article outlines the diagnostic pathway using the patient’s history, physical examination and ultrasound examination. It is important to correlate the clinical assessment with the imaging signs. It is also important to treat the patient and not the images as there may be abnormalities detected on imaging that are not symptomatic. The article covers the important diagnosis of subdeltoid subacromial bursitis, glenohumeral joint capsulitis, calcific tendinosis, acromioclavicular joint osteoarthritis and long head of biceps tendinosis. It will guide the reader in how to use the findings to treat, using ultrasound-guided injection and other techniques, including steroid injections, hydrodilatation, barbotage and extracorporeal shockwave treatment. These are discussed with the knowledge from over 30 years of experience with a literature review evidential support. I have included tips to make these procedures more effective in treatment and final outcome. There is discussion regarding the use of steroid injections in the presence of a rotator cuff tear and how to proceed if the patient has more than one disease process. The sensible use of steroids and local anesthetics are included, bearing in mind that lidocaine and high concentrations of long-acting local anesthetics are chondrotoxic and should not be injected into joints.
PL
Postawienie odpowiedniej diagnozy u pacjentów z bólem barku jest kluczowe. W przypadkach, w których rozważa się leczenie operacyjne, ultrasonografia stanowi niezwykle istotną metodę obrazową, zarówno diagnostyczną, jak i terapeutyczną. W niniejszym artykule opisano ścieżkę diagnostyczną, która uwzględnia badanie podmiotowe, przedmiotowe oraz ultrasonograficzne. Niezwykle ważna jest korelacja obrazu ultrasonograficznego z oceną kliniczną, gdyż pacjent nie powinien otrzymywać leczenia w związku z wykrytymi w badaniu obrazowym patologiami, które nie wywołują żadnych dolegliwości. W artykule opisano ważne patologie, takie jak zapalenie kaletki podnaramienno-podbarkowej, zapalenie torebki stawu łopatkowo-ramiennego, zmiany tendinopatyczne z wytwarzaniem zwapnień, zmiany zwyrodnieniowe stawu barkowo-obojczykowego oraz zmiany tendinopatyczne ścięgna głowy długiej mięśnia dwugłowego ramienia. Czytelnik znajdzie wskazówki sposobu leczenia widocznych w badaniu ultrasonograficznym patologii za pomocą iniekcji wykonywanych pod kontrolą obrazu ultrasonograficznego, a także z użyciem innych metod, takich jak podanie środków sterydowych, podanie płynu do jamy stawu w celu rozciągnięcia torebki stawowej, barbotaż i fala uderzeniowa. Informacje podparte są ponad 30-letnim doświadczeniem oraz dowodami naukowymi z dostępnych publikacji. Aby opisane metody leczenia były skuteczne, a afekt końcowy zadowalający, podano wskazówki jak należy je wykonywać. Nadal trwa dyskusja, czy należy stosować środki sterydowe w uszkodzeniu ścięgien stożka rotatorów, a także jak postępować z pacjentami, u których stwierdzono kilka procesów chorobowych. Środki sterydowe i leki miejscowo znieczulające należy stosować rozważnie, pamiętając, że lidokaina i wysokie stężenia długodziałających leków miejscowo znieczulających mają działanie chondrotoksyczne i nie powinny być podawane do jamy stawu.
Gastrooesophageal reflux disease is the regurgitation of stomach contents into the esophagus, which causes troublesome symptoms or complications for the patient. Before starting the treatment, it is always necessary to objectively confirm gastroesophageal reflux disease, especially in correlation with ENT symptoms, as extra esophageal complications. In diagnostics, the "gold standard" is a 24-hour impedance-pH supplemented with endoscopy. Treatment without objective confirmation of the disease is not recommended, the more so that non-acid gas proximal reflux, detectable only in the MIIpH test, causes the greatest number of laryngological complications. It is important to confirm the coexistence of clinical symptoms of GERD with ESS. Considering the time of treating the disease and its consequences, it is worthwhile to be cautious and careful with the diagnosis of the disease, and the treatment should be carried out for a long time in relation to the recommendation, preferably in cooperation with an ENT specialist and gastroenterologist. The greatest therapeutic effectiveness is achieved by combining PPI with itopride while maintaining the appropriate doses of drugs and observing a sufficiently long duration of treatment, while maintaining the correct dose reduction and drug discontinuation regimen. In case of failure of pharmacological treatment, antireflux surgery should be take into consideration.
Purpose. One of the basic operational goals of early physical education is the early recognition of athletic potential in children. When examining the presence of talent, it is necessary to consider the specific nature of a given sport, especially if it is a team sport, and the fact that skill in playing a sport is determined not only by featuring a high level of applicable motor abilities. Within this context, the aim of this study was to determine what dependencies existed between the methods frequently used to assess talented children in the game of handball, specifically targeted sports and motor tests. The popularity of these diagnostic methods is based on the theory that achievement in sports is accompanied by a high level of physical ability. Therefore, the practical aim of the study was to improve the accuracy of recognizing and examining sports talent. Methods. A group of 21 twelve-year-old boys were recruited, all of whom were involved in a sports program that specialized in handball. Talent was identified by the observation, analysis, and interpretation of the participants’ (1) general physical ability - assessed by the Eurofit test battery, (2) targeted physical ability - measured by specific hardball skills such as moving with the ball, catching and passing the ball, and throwing the ball from a distance, and (3) innate in-game behavior - based on a ranking of thirteen behavioral categories exhibited during the course of a game. Results and conclusion. The correlation coefficients adopted in this study indicated a high dependency between the three methods used to identify potential talent in handball. This indicates that young athletes who score relatively well in one test are likely to attain positive results in the other two methods.
Introduction: Neonatal cystic fibrosis screening contributes to an early diagnosis of cystic fibrosis and to implementing appropriate therapeutic management. Long-standing screening tests have made it possible to identify a group of newborns in whom the diagnosis was ambiguous and required further specialised tests. Aim: The aim is to present cases of patients with a positive result of newborn screening for cystic fibrosis who were found to be carriers of the mutation in both alleles, however the lack of clinical symptoms and correct sweat testing values did not lead doctors to diagnosing cystic fibrosis and by the same token implementing the treatment. Material and methods: The analysis encompassed agroup of 22 infants and children 3 months to 3 years of age, in whom, in spite of a positive result of newborn screening for cystic fibrosis and the presence of 2 mutations in the CFTR gene, the diagnosis of cystic fibrosis was not made, and appropriate treatment was not administered because of diagnostic doubts (due to correct concentration of chlorides in sweat, correct IRT level and lack of clinical signs of cystic fibrosis). The control group consisted of 55 children treated in our centre, in whom neonatal screening for cystic fibrosis was positive and the diagnosis was confirmed by genetic testing, sweat chloride testing and IRT concentration. Results: There were no differences in birth body weight between the groups. The differences in chloride ion levels in sweat secretion tests and mean IRT values were statistically significant and were: 97.5 for the control group and 26.4 for the test group. At the present time there are no clinical symptoms to give a diagnosis of cystic fibrosis and start treatment in the test group. Conclusions: Newborn screening contributes not only to an early diagnosis of cystic fibrosis but also to CFTR-related metabolic syndromes (CRMS), which is a phenomenon requiring further observation. This fact constitutes a definite psychological problem for the parents of these patients.
PL
Wstęp:Badania przesiewowe noworodków w kierunku mukowiscydozy dają możliwość wczesnego rozpoznania choroby i wdrożenia odpowiedniego postępowania terapeutycznego. Długoletnie prowadzenie badań przesiewowych pozwoliło wyodrębnić grupy dzieci, u których postawienie rozpoznania mukowiscydozy nie było jednoznaczne i wymagało dalszych specjalistycznych badań. Cel pracy: Celem pracy jest przedstawienie przypadków pacjentów z dodatnim wynikiem noworodkowych badań przesiewowych w kierunku mukowiscydozy, u których wykryto obecność mutacji genu CFTR w obu allelach, natomiast brak objawów klinicznych oraz prawidłowe wartości testów potowych nie upoważniły do rozpoznania choroby, a tym samym do włączenia leczenia. Materiał i metody: Badaniami objęto 22 niemowląt i dzieci w wieku od 3 miesiąca do 3. roku życia, u których mimo dodatniego wyniku badania przesiewowego w kierunku mukowiscydozy istwierdzenia w badaniu genetycznym 2 mutacji genu CFTR, nie rozpoznano mukowiscydozy (CF) i nie rozpoczęto leczenia ze względu na wątpliwości diagnostyczne (prawidłowe stężenie chlorków w pocie i prawidłowe stężenie IRT oraz brak klinicznych objawów CF(grupa badana). Za grupę kontrolną uznano 55 dzieci leczonych w naszym ośrodku, u których test przesiewowy w kierunku CF wypadł dodatnio, a rozpoznanie potwierdzone zostało badaniem genetycznym oraz badaniem stężenia chlorków w pocie istężeniem IRT. Wyniki: Nie stwierdzono różnic w zakresie masy urodzeniowej ciała między grupą badaną a kontrolną. Natomiast różnice w stężeniu chlorków w pocie i w stężeniu IRT były istotne statystycznie i wynosiły: dla grupy kontrolnej (średnio) − 97,5, a dla grupy badanej 26,4. W chwili obecnej u dzieci z grupy badanej nie stwierdzono objawów klinicznych dających podstawę do rozpoznania CF i rozpoczęcia leczenia. Wnioski: Badanie przesiewowe noworodków przyczynia się do wczesnego rozpoznania nie tylko mukowiscydozy ale także CFTR-zależnych zespołów metabolicznych wymagających dalszej obserwacji. Fakt ten stanowi poważny problem psychologiczny u rodziców tych dzieci.
Objective: The aim was to determine the clinical characteristics and analysis of surgical treatment of patients with glomus tympanicum hospitalized in the Department of Otorhinolaryngology. Material and methods: Between 2000 and 2015, 27 patients were hospitalized. Age ranged 28-79 years old. The study analyzed data from the clinical examination and the type of surgical technique. Results: The most common symptoms were tinnitus and hearing loss. Resection of the tumor was performed by anterior tympanotomy in 3 (11,1 %), CWU mastoidectomy in 21 (77,8 %), CWD mastoidectomy in 1 (3,7 %), lateral petrosectomy in 2 (7,4 %) patients. Conclusion: Glomus tympanicum have a quite characteristic clinical picture with dominant symptoms of tinnitus, hearing loss and reddening of the tympanic membrane in otoscopic examination. This type of tumors require surgical treatment. Surgical access depends on the size of the tumor in the tympanic cavity. Most of these tumors can be removed using antromastoidectomy, with posterior tympanotomy and hypotympanotomy.
Coronary artery anomalies are rare but sometimes important findings in the evaluation of the coronary artery. The majority of the anomalies are of benign prognosis, but others can be associated with cardiac symptoms and syndromes (angina, dyspnea, syncope, congestive heart failure, myocardial infarction and sudden death). The potentially serious anomalies include: ectopic coronary origin from the pulmonary artery; ectopic coronary origin from the opposite aortic sinus; and large coronary fistulae. Appropriate diagnosis is critical for recognition and management. Treatment can be performed by surgical or percutaneous approach. However, management is conservative in the majority of them. Contemporary diagnosis and clinical management of these anomalies are briefly reviewed and discussed in this article.
Background: Esophageal perforation is a life-threatening condition of a complex etiology. No clear guidelines are available regarding the management of this condition. In this study, we review publications related to esophageal perforation, and analyze patients treated for this condition at our Department of Thoracic, General and Oncological Surgery. Objective: The objective of the study was to retrospectively assess and analyze management methods for esophageal perforations of different etiologies. All patients were treated in the Department of Thoracic, General and Oncological Surgery in years 2009-2015. Patients with perforations resulting from post-operational leaks within surgical anastomoses were excluded from the study. Material, methods, results: The analysis involved a total of 16 cases of esophageal ruptures. All cases were treated in years 2009-2015. Patients with perforations resulting from postoperative leaks within surgical anastomoses following elective surgeries for either oncological or non-oncological causes were excluded. The most common reason for esophageal rupture was iatrogenic injury (7 cases, 44%). Other causes included Boerhaave syndrome (5 cases, 31.2%), blunt trauma (2 cases, 12.5%), abscess perforation (1 case, 6.2%), and ulcer perforation (1 case, 6.2%). Ten patients underwent surgery, and the rest underwent esophageal prosthesis placement, of whom 2 cases required drainage of the mediastinum and pleural cavity. The mortality rate in the study group was 9/16 cases (56.2%). Conclusions: Esophageal perforation poses a significant interdisciplinary challenge regarding diagnostic workup, selection of treatment methods, and management of potential postoperative complications. This retrospective study was conducted in a single center. Although the analyzed period was long, we found only 16 cases. In spite of a variety of etiologies present, we found several statistically significant results of potential clinical value. 1. Most perforations that are not diagnosed within 48 hours affected the lower part of the esophagus and presented with unclear symptoms and imaging findings 2. Delaying diagnosis and treatment beyond 24 hours was associated with a higher mortality rate.
Cervical branchial cleft cysts are relatively common tumors of the neck that should be distinguished from an epidermoid cyst, hygroma, hemangioma, lymphangioma, lymphadenitis, and metastatic papillary carcinoma of the thyroid gland. Infected cysts might be misdiagnosed as a recurrent abscess. The aim of the study was to present current views concerning diagnosis and treatment of cervical branchial cleft cysts. Material and methods. Data and histopathological results obtained from 49 patients (18 women and 31 men) admitted to the Department of Cranio-Maxillofacial Surgery, due to lateral cervical cysts during the period between 2005 and 2009 were subject to retrospective analysis. Results. Most patients were in their third decade of life. The clinical examination showed a painless, slowly growing tumor on the lateral surface of the neck, more often on the right side, and in 30 cases with a concomitant infection. Initial diagnosis on the basis of the clinical examination, radiology and biopsy was confirmed in 48/49 cases (98%). All patients were subject to surgical treatment. During the 3 to 7 year follow-up period recurrence was not observed. Conclusions. Initial diagnosis of a cervical branchial cleft cyst on the basis of the clinical examination should always be confirmed by means of ultrasonography. In case of suspicion of a coexisting infection, fine-needle aspiration biopsy under ultrasound control is recommended. If there is concern that the lateral neck lesion is not a branchial cyst or its dimension is large, computed tomography of the neck or magnetic resonance should be performed. Complete excision of the tumor under general anesthesia is the treatment of choice, being associated with the low risk of local postoperative complications
Dental erosion is described as an irreversible loss of dental hard tissue resulting from exposure to non-bacterial acids or chelating substances. It may be caused by exogenous or endogenous factors. In the former case, food, drink, as well as the environment might be sources of acids; in the latter, acids flowing into the oral cavity from the stomach and duodenum. Exogenous dental erosive lesions are localized mainly on the labial surfaces of the anterior teeth of the maxilla, while the endogenous ones can be found on the palatal and masticatory surfaces of the maxilla and the masticatory and buccal surfaces of the mandible. Reduced saliva secretion, which occurs in a number of diseases, also influences dental erosion, while erosion-causing factors and aggressive tooth brushing immediately after consuming acidic food increases the range and depth of erosion cavities. The consequence of dental erosion is teeth hypersensitivity, which results from exposure of dental tubules and of the pulp leading to the loss of tooth vitality and decrease in occlusal height. Treatment of exogenous dental erosion consists in changing nutritional and hygienic habits. In the case of endogenous erosion, however, the therapy should address mainly an underlying disease. Worn teeth surfaces should be restored with conservatory or/and prosthetic methods. In the context of an increasing prevalence of dental erosion in the population, it is necessary to develop and implement prophylactic measures, including broadly understood health education on the risk factors, preventive activities, and possibilities of diagnosis and therapy.
Introduction As many as 80% of adults suffer from low back pain. Therefore, it is significant to develop an effective and reliable method of diagnosing and treating low back pain. One of the rehabilitation methods is a mechanical diagnosis and therapy method developed by Robin McKenzie. The aim of the study was to review the publications assessing the effectiveness of McKenzie Method in diagnosis and therapy of low back pain and to compare it with other widely applied physiotherapeutic methods. Material and methods The analysis included 50 articles from the last 20 years dealing with the issue of diagnosis and therapy of low back pain with the use of McKenzie Method. After the application of inclusion criteria, 22 publications were taken into account in the final analysis. The following databases were used: Google Scholar, PubMed, the Library of the Centre of Postgraduate Medical Education and the Main Medical Library. Results The research revealed high effectiveness of McKenzie Method in diagnosing pain depending on the level of qualifications of therapists applying this method. It was concluded that McKenzie Method is an effective solution in low back pain therapy as it produced better results than standard rehabilitation and similar results to other therapeutic methods. Conclusions A complete training regarding this method is significant for achieving high effectiveness of diagnosis. The combination of McKenzie Method with other forms of therapy gave the best results in improving spinal mobility and general quality of life as well as reducing the level of disability.
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