Described in the literature dehiscence rate in the adult population is 0.3-3.5%, and in the elderly group as much as 10%. In about 20-45% evisceration becomes a significant risk factor of death in the perioperative period. The aim of the study was to identify the main risk factors for abdominal wound dehiscence in the adult population. Material and methods. The study included patients treated in the 3rd Department of General Surgery, Jagiellonian University Collegium Medicum in Cracow in the period from January 2008 to December 2011, in which at that time laparotomy was performed and was complicated by wound dehiscence in the postoperative period. For each person in a research group, 3-4 control patient were selected. Selection criteria were corresponding age (± 2-3 years), gender, underlying disease and type of surgery performed. Results. In 56 patients (2.9%) dehiscence occurred in the postoperative period with 25% mortality. The group consisted of 37 men and 19 women with the mean age of 66.8 ± 12.6 years. Univariate analysis showed that chronic steroids use, surgical site infection, anastomotic dehiscence/fistula in the postoperative period and damage to the gastrointestinal tract are statistically significant risk factors for dehiscence. Two first of these factors occurred to be independent risk factors in the multivariate analysis. In addition, due to the selection criteria, a group of risk factors should also include male gender, emergency operation, midline laparotomy, colorectal syrgery and elderly age (> 65 years). Logistic regression analysis did not show that a particular surgeon, time of surgery or a particular month (including holiday months) were statistically significant risk factor for dehiscence. Conclusions. Wound dehiscence is a serious complication with relatively small incidence but also high mortality. Preoperative identification of risk factors allows for a more informed consent before patient’s treatment and to take measures to prevent or minimize the consequences of complication associated with it.
Colorectal cancer is one of the most commonly diagnosed cancer and a leading cause of death from cancer. DNA repair defects have been associated with an individual susceptibility to cancer. Therefore, polymorphisms of DNA repair genes, including XRCC1 gene, are suspected to may increase the risk of colorectal cancer.The aim of the study was to examine the association between Arg399Gln polymorphisms of XRCC1 gene and the occurrence of colorectal cancer. Research and understanding of the molecular basis of the formation of colorectal cancer will allow for typing of genetically loaded persons and qualifying them to a high-risk group.Material and methods. In case-control study we genotyped 150 colorectal cancer patients and 170 healthy subjects from Polish population. Analysis was performed by PCR-restriction fragment length polymorphism (PCR-RFLP).Results. We found that Gln/Gln genotype is associated with increased risk of colorectal cancer (OR 1.984; Cl 95% 1.070-3.677; p=0.029). We also found that Arg/Gln genotype is a risk factor for progression of tumor growth (OR 3.52; Cl 95% 1.157-10.707; p=0.023).Conclusions. The current state of research suggests a link between Arg399Gln XRCC1 polymorphism and increased risk of colorectal cancer. Therefore, we conclude that the Arg399Gln polymorphism of XRCC1 gene may underlie at the molecular basis of the causes of colorectal cancer.
The heterogeneous population of patients affected by trauma is extremely difficult to systematize. This is due to the diversity of mechanisms of injury, the nature and severity of the injury and the population, which relate to injuries, diverse in terms of gender, age, presence of comorbidities that make up the final severity of the injury and a certain degree of danger to life. The aim of the study was to develop a universal method to assess the severity of injury and loss of life resulting from their consequences, using the parameters available in the Polish administrative databases, a similar diagnostic efficacy as other used scales to assess the severity of damage. Material and methods. The study analyzed a group of 92 463 patients hospitalized due to injuries sustained as a result of injuries in all hospitals of the Lublin region in 2003-2005. Developed catalogs risk factors, reference to the population of the Lublin province. Results. Developed five models predictive of injury severity scale counterparts, which include different combinations of risk factors associated with the type of injury, age of the patient and the mechanism of injury that have been evaluated for their diagnostic efficacy in differentiating the expected outcomes. Prediction model have the best diagnostic efficacy AUROC 0.9615, SE 0.0025 and 95% CI 0,9565-0,9665, hereinafter referred to as Life Hazard Ratio (LHR), which has a similarly high diagnostic efficacy as the other, examined in the work of the rock assess the severity of damage AUROC 0.9585, SE 0.0368, 95% CI0 0.8849-1. Conclusions. 1. The proposed method of use of the International Classification ICD-10 allows the use of regional administrative databases to conduct detailed analyzes of population and monitor trends in the epidemiology of injuries. 2. Developed Life Hazard Ratio (LHR)is a universal method for the objective evaluation of the severity of injuries and the associated risk of life-threatening, can also conduct population studies. 3. LHR has a comparable rate of diagnostic efficacy as other commonly used scales assessing the severity of the injury.
Purpose. Results of treatment of locally advanced larynx cancer T3-4No-4 are unsatisfi ed. The aim of study is analysis of risk factors. Methods and Materials. 112 patiens with larynx cancer after radical surgical treatment had postoperative radiotherapy (conventional or accelarated). Results. The 3-year overall survival (OS) was 58%. Margin status and numer of risk factors had impast on OS. The 3-year locoregional control (LRC) was 80%. Number of risk factors, level of hemoglobin, overall tratment time and dose were signifi cantly associated with LRC. Incidence of distant metastases was asssociated with G3 suamous cell carcinoma and index of nalignancy H. Glanz.
The 30-day mortality is one of the factors reflecting the quality of treatment. All these efforts focused on decreasing 30-day mortality will directly improve quality of care. The aim of the study was to identify risk factors of 30-day postoperative mortality in a cohort of patients operated on for colorectal cancer in one tertiary colorectal centre. Material and methods. Patients operated on due to colorectal cancer (CRC) between 2008 and 2014 were included in the study. 30-day mortality was assessed as an endpoint of the retrospective study. All records were collected from prospective database. Results. 1744 patients were operated on due to CRC. The 30-day mortality was noted in 65 patients (3.5%). In multivariable analyses we revealed that spread disease and poor general condition at admission were risk factors of 30-day mortality: OR 2.35; 2.01‑2.57 95%CI, p=0.03 and OR 2.18; 1.95‑2.41 95% CI; p=0.01, respectively. Emergency surgery significantly increased the risk of 30-day mortality: OR 2.64; 2.45‑2.87 95%CI; p=0.009. Low serum albumin concentration level and diabetes mellitus were additional risk factors for 30-day mortality, OR 1.65; 1.52‑1.78 95%CI; p=0.01 and OR 1.67; 1.41‑1.82 95%CI; p=0.03, respectively. Mortality was significantly higher after resection procedures than after only palliative operations: 4.21% vs 1.57%; p=0.002. Conclusions. Emergent patients, patients with advanced disease and in poor general state have to be assessed by multidisciplinary team to prepare them to operation. Additionally to reduce the risk of 30-day mortality decision of extend of surgery should be made by experienced surgeons.
Assessing the risk factors according to EORTC (European Organization of Research and Treatment of Cancer) or HD IPS (Hodgkin’s lymphoma International Prognostic Score) is crucial for choosing the adequate I line therapy in Hodgkin’s lymphoma patients. However, none of those scales predicts the efficacy of autologous stem cell transplant (ASCT) in relapsing/refractory (R/R) patients. Progression- free survival (PFS) after ASCT corelates with the response to salvage regimens. Thirty-nine Hodgkin’s lymphoma patients transplanted at Jagiellonian University Department of Hematology with a follow-up exceeding 5 years were analyzed. Despite long time periods since the diagnosis, initial serum albumin levels seem to correlate with progression after autologous stem cell transplant and indicate high probability of relapse within 5 months following the procedure with favorable test characteristics.
Introduction: The aim of the study was to analyse the risk factors for oral cavity and oropharynx cancer in peopled examined under the Head and Neck Cancer Awareness Week in 2016, Lodz. Material and methods. In Lodz, 21st September 2016, under the Head and Neck Cancer Awareness Week, 106 people, including 67 women aged 29–77 and 39 men aged 23–84, underwent preventive examinations in the hospital department. Prior to the laryngological examination, the patients were asked to answer questions that referred to their education, medical case history, symptoms, smoking habits with the number of cigarettes per day, alcohol intake, the number of lifetime sexual partners, oral sex engagement, incidents of head and neck cancer in the family history. Results: The major part of the examined patients were women and men with the secondary and high level of education, 47,76% and 35,82%, and 58,97% and 35,91% respectively. The patients were informed by mass media about the planned preventive medical examinations – 80,60% women and 79,49% men. The most common symptoms reported by women were: hoarse voice in 61,19% cases, dysphagia in 32,84% cases and burning sensation and/or pain in the oral cavity in 29,85% cases. The examined male patients mainly showed hoarse voice (46,15%), other symptoms (43,59%) and dysphagia (25,64%). 28,35% women and 28,20% men smoked cigarettes, while passive smokers were 22,38% and 25,64% respectively. Alcohol consumption was reported by 67,16% women and 82,05% men, rather occasionally. Having oral sex was noted in 25,37% women and 38,46% men, mostly with multiple sexual partners. Among the studied patients, 13,43% women and 5,12% men suffered from malignant cancer, including 2,98% women and 2,56% men who reported head and neck carcinoma in the medical interview. On the basis of the interview and ENT examination, 11,94% women and 17,94% men were qualified for the extended oncological diagnostics. Conclussion. The Fourth Head and Neck Cancer Awareness Week shows the increased interest in preventive screening, especially oncological screening, and thus the necessity of such preventive activities in the future.
Introduction: The aim of the study was to analyze the risk factors for oral cavity and pharyngeal cancer in people examined under the Head and Neck Cancer Prophylaxis Program. Material and methods: The study was conducted in a total of 300 patients, including 186 women and 114 men, as part of the Head and Neck Cancer Prevention Program in 2014–2018. Before the laryngological examination, the patients completed a demographic and medical questionnaire regarding the risk factors of head and neck cancer, including education, reported disease symptoms, smoking addiction, number of cigarettes smoked daily, alcohol consumption, frequency of visits in a dental office, oral hygiene measures, number of sexual partners, oral sex, family medical history of head and neck cancer. Results: The subjects reported the following symptoms: hoarseness 43.33%, difficulty swallowing 21.33%, pain or mouth burning 20.33% and other symptoms were observed in 46.33%. The main dental symptoms were: bleeding from the gums during teeth brushing in 48.89%, dry mouth 45.56%. Currently 20.33% of respondents smoke, whereas 54% of patients smoked in the past. In the analyzed material, the majority (80%) consumed alcoholic beverages. 27.67% of respondents admitted having oral sex, including 24.73% of women and 32.46% of men. After performing the extended diagnostics, the tumor was found in 10% of the subjects. C onclusions: Statistical significance of differences was found: between hoarseness and alcohol consumption, both in women and in men, between hoarseness and smoking in women, between difficulty in swallowing and smoking in women, between burning/pain in the mouth and smoking in men, between hoarseness and the cultivation of oral sex in men, between the difficulty of swallowing and the practice of oral sex in the studied men and between burning/pain in the oral cavity and the occurrence of malignancy.
Introduction: Thanks to the Polish Universal Neonatal Hearing Screening Program (PUNHSP), all newborns in Poland undergo a free, screening hearing examination. Between 2006 and 2015, the average number of tested children per year was 373,477. According to the analysis of The Central Database (CDB), only 55.8% of the children attended the detailed hearing examinations at the second level of the Program. Aim: The aim of this study is to analyse the dates concerning the attendance of the children at the diagnostic level of PUNHSP in different regions of Poland. Materials and methods: To conduct an analysis of this fact and find out the reasons for low attendance at the second level in 2015, a telephone survey questionnaire was developed for parents who had not registered their babies for further consultation – 3,239 randomly selected parents. Results: The analysis revealed that the number of children examined at the second diagnostic level of the program is in fact much higher than the results of The Central Database show. The actual number is 83.6% as opposed to 55.8%. As a result of the telephone questionnaire some inaccuracies in the input data to the CDB were detected. The main errors in gathering the information for the CDB were incorrect OAE test result and no examination performed. C onclusion: In Poland the worst results (i.e. questionnaire results compared to CDB) for the attendance at the diagnostic level were shown in Pomorskie, Lubelskie, Mazowieckie and Podlaskie regions. In many cases there was a large discrepancy between the reality and the information in the CDB. The improvement of clarity concerning the CDB application is important in order to minimise the possibility of malformation in the CDB.
Breast cancer is the most common result of mutual correlation between hormonal determinants, environmental and genetic. Mechanisms of its development include: high estrogen concentration, impaired glucose metabolism, hyperglycemia, hyperinsulinemia, high levels of insulin-like growth factor 1, persistent inflammation and oxidative stress, and impaired cellular apoptosis. The aim of the study was to analyze data on the risk factors of breast cancer, which have been divided according to the period of diagnosis for pre-menopausal and postmenopausal. Due to the fact that a large part of the determinants of the occurrence of this cancer is modifiable, it is necessary to raise the awareness of the population about it. Maintaining proper body mass through the use of a balanced diet rich in calcium, non-starch vegetables and products rich in carotenoids, while limiting alcohol consumption and care for physical activity, are the best prevention of breast cancer. At the same time, further research is needed to explain the uncertainty of current observations.
Introduction: Thanks to the Polish Universal Neonatal Hearing Screening Program (PUNHSP), all newborns in Poland undergo a free, screening hearing examination. Between 2006 and 2015, the average number of tested children per year was 373,477. According to the analysis of The Central Database (CDB), only 55.8% of the children attended the detailed hearing examinations at the second level of the Program. Aim: The aim of this study is to analyse the dates concerning the attendance of the children at the diagnostic level of PUNHSP in different regions of Poland. Materials and methods: To conduct an analysis of this fact and find out the reasons for low attendance at the second level in 2015, a telephone survey questionnaire was developed for parents who had not registered their babies for further consultation – 3,239 randomly selected parents. Results: The analysis revealed that the number of children examined at the second diagnostic level of the program is in fact much higher than the results of The Central Database show. The actual number is 83.6% as opposed to 55.8%. As a result of the telephone questionnaire some inaccuracies in the input data to the CDB were detected. The main errors in gathering the information for the CDB were incorrect OAE test result and no examination performed. C onclusion: In Poland the worst results (i.e. questionnaire results compared to CDB) for the attendance at the diagnostic level were shown in Pomorskie, Lubelskie, Mazowieckie and Podlaskie regions. In many cases there was a large discrepancy between the reality and the information in the CDB. The improvement of clarity concerning the CDB application is important in order to minimise the possibility of malformation in the CDB.
The work aimed at specifying modern features of civilizational factors influence on the health, revealing peculiarities of young age, establishing reflexion of modern factors of health in methodological approaches to health studying. Changes in understanding health are reflected in its studying methodology. The analysis of sociological research data shows, that the social stress became the main reason of medical-demographic situation deterioration in days of reforms. The mechanism of its influence was the loss of effective labor motivation, social envy, and deterioration of spiritual condition of a society. Material well-being decrease was not a determinative factor. The problem of inequalities in health gets the increasing urgency. It is connected with physical and social living environment; availability of qualitative medical aid; specific features of behavior of people. At a medical aid guarantee, and at teenage age, factors of social living environment, which influence behavior in health sphere by means of stigmatization are especially significant.
Objectives: The aim of the study was the analysis of the epidemiology of laryngeal cancer over 10 years in relation to known risk factors and to assess the current survival rates in this group of patients. Methods: The data were retrospectively collected from patients’ medical records, then entered in the database using dedicated software and a statistical analysis was performed. Results: 512 subjects - 443 men (86.5%) and 69 women (13.5%) were enrolled into the study. The male-to-female ratio was 6.4:1. There were 97.1% smoking women and 98% smoking men, however the history of more than 20 cigarettes per day smoking admitted 81.1 % of women and 94.6% of men. Heavy alcohol consumption was the case in 14 (20.3%) women and in 307 (69.3%) men. For both the size of heavy alcohol consumption and the size of excessive tobacco use, there was found statistically significant difference between women and men with laryngeal cancer (p<0.05). In the majority of male and female subjects, the tumour was located in the supraglottis/glottis area. Apparently this tumour location was much more common among women, accounting for 60.9% of cases , while in men was confirmed in 39.3% of cases. The stages of the laryngeal cancer were similarly of high advancement for both the men and women - stages III and IV were confirmed in 82.6% of women and in 77.6% of men. The over 5-year survival rate was 39.1% among women and 37.2% among men. Conclusions Contradictory to decreased exposure to risk factors and the shorter period for diagnosis, the higher stages of cancer were observed in women. Although in women the advancement was higher and the majority of cases were located in unfavourable supraglottic area, the survival rates were higher. Key words: laryngeal cancer, epidemiology, men and women, risk factors
The goal of this study is to evaluate therapeutic trends for several diseases that represent risk factors for stroke. The relative frequency of therapy with compounds that influence the risk factors for stroke was monitored in a group of 3,290 patients who were hospitalised in the Stroke Unit at the University Hospital in Hradec Kralove between 2005 and 2012. For most drugs monitored, the reasons for the significant decrease or increase in use were causes other than the reduction of stroke risk. Despite this finding, the majority of statistically significant changes had, according to review of comparative studies, a posi- tive effect on prevention of stroke. Motivation to change treatment of stroke risk factors, such as hypertension, diabetes mellitus and hypercholesterolemia, was mainly aimed at sufficient disease management with a minimum of adverse effects. On the other hand, optimization of stroke recurrence and economic factors were motivations to treatment changes in prevention with antiplatelets. Antidiabetics were associated with an increase in met- formin use and reduction in insulin use. For antihyperten- sives, the most significant reduction was associated with the use of diuretics, although calcium channel blockers and beta-blockers are also less used. Additionally, the use of the ACE inhibitor ramipril increased
Introduction: The aim of the study was to analyze the risk factors for oral cavity and pharyngeal cancer in people examined under the Head and Neck Cancer Prophylaxis Program. Material and methods: The study was conducted in a total of 300 patients, including 186 women and 114 men, as part of the Head and Neck Cancer Prevention Program in 2014–2018. Before the laryngological examination, the patients completed a demographic and medical questionnaire regarding the risk factors of head and neck cancer, including education, reported disease symptoms, smoking addiction, number of cigarettes smoked daily, alcohol consumption, frequency of visits in a dental office, oral hygiene measures, number of sexual partners, oral sex, family medical history of head and neck cancer. Results: The subjects reported the following symptoms: hoarseness 43.33%, difficulty swallowing 21.33%, pain or mouth burning 20.33% and other symptoms were observed in 46.33%. The main dental symptoms were: bleeding from the gums during teeth brushing in 48.89%, dry mouth 45.56%. Currently 20.33% of respondents smoke, whereas 54% of patients smoked in the past. In the analyzed material, the majority (80%) consumed alcoholic beverages. 27.67% of respondents admitted having oral sex, including 24.73% of women and 32.46% of men. After performing the extended diagnostics, the tumor was found in 10% of the subjects. C onclusions: Statistical significance of differences was found: between hoarseness and alcohol consumption, both in women and in men, between hoarseness and smoking in women, between difficulty in swallowing and smoking in women, between burning/pain in the mouth and smoking in men, between hoarseness and the cultivation of oral sex in men, between the difficulty of swallowing and the practice of oral sex in the studied men and between burning/pain in the oral cavity and the occurrence of malignancy.
In recent decades a significant raise in the incidence of myocardial infarction among young women has been recorded. It is presumed that, apart from the classical risk factors, other reasons exist for premature atherosclerosis in young women, related to the homeostasis of gonadal hormones. The aim of the study was to analyze the levels of gonadal hormones (estradiol, progesterone, follicle-stimulating hormone, luteinizing hormone, testosterone and dehydroepiandrosterone) measured in the luteal phase, in 65 normally menstruating women post myocardial infarction (MI) and to investigate a possible relationship between the hormone profile and selected coronary artery disease (CAD) risk factors. The levels of gonadal hormones: estradiol, progesterone, follicle-stimulating hormone, luteinizing hormone, testosterone and dehydroepiandrosterone were measured in the luteal phase. All examined women had normal mean levels of gonadal hormones. In the post MI patients leading a sedentary life style, a significantly lower mean progesterone concentration was observed (16.29 ± 9.11 versus 29.43 ± 21.14 nmol/l, p < 0.05) and significantly higher mean testosterone concentration (2.34 ± 0.98 versus 1.76 ± 1.09 nmol/l, p < 0.05) when compared to patients from the same group, but leading a more active life. In obese post MI women (BMI ≥ 30 kg/m2) a lower mean concentration of progesterone was detected (18.02 ± 8.12 versus 26.16 ± 14.72 nmol/l, p < 0.05), than in slimmer patients from the same group. In post MI women with a positive family history for CAD, a significantly higher mean concentration of testosterone was detected (2.31 ± 1.22 versus 1.67 ± 0.74 nmol/l, p < 0.05) than in patients with no family history. The results suggest a correlation between levels of gonadal hormones and classical CAD risk factors.
ntroduction: Lower limb amputation is a surgery performed as a last resort, when all other therapeutic options have been exhausted. The duration of treatment lasts from a few to several months and depends on the extent of amputation, the patient's overall health and the course of the stump healing process. Materials and methods: A retrospective analysis was performed using the database of the General and Vascular Surgery Ward of the Nikolay Pirogov Regional Specialist Hospital in Łódź. Patients who underwent lower limb amputation at the transfemoral level in 2017 were analyzed. 92 patients undergoing surgery were qualified for the study. Patients were divided into two groups: those with no healing complications and those with stump healing complications. Medical records of both groups were analyzed for risk factors for impaired healing. The obtained data were subjected to statistical analysis. Results: Patients with impaired stump healing most often had minimal bleeding and higher ASA scores compared to patients without healing complications. No differences between the two groups were found for the remaining parameters. Patients with complications needed an average of 28 days to heal the wound and spent an average of 40 days in hospital, compared to 14 and 21 days, respectively, for patients without complications. The percentage of deaths in the group of patients with complications was also significantly higher (35%) than in the group of patients without complications (5%). Conclusions: Statistically significant factors increasing the risk of impaired stump healing include high ASA scale and minimal muscle bleeding during surgery. Patients who experienced this complication are at greater risk of prolonged hospitalization and death in the postoperative period. This study showed statistically significant risk factors for impaired stump healing following amputation and confirmed the negative impact of this complication on the length of hospitalization and risk of death.
Objectives: The aim of the study was the analysis of the epidemiology of laryngeal cancer over 10 years in relation to known risk factors and to assess the current survival rates in this group of patients. Methods: The data were retrospectively collected from patients’ medical records, then entered in the database using dedicated software and a statistical analysis was performed. Results: 512 subjects - 443 men (86.5%) and 69 women (13.5%) were enrolled into the study. The male-to-female ratio was 6.4:1. There were 97.1% smoking women and 98% smoking men, however the history of more than 20 cigarettes per day smoking admitted 81.1 % of women and 94.6% of men. Heavy alcohol consumption was the case in 14 (20.3%) women and in 307 (69.3%) men. For both the size of heavy alcohol consumption and the size of excessive tobacco use, there was found statistically significant difference between women and men with laryngeal cancer (p<0.05). In the majority of male and female subjects, the tumour was located in the supraglottis/glottis area. Apparently this tumour location was much more common among women, accounting for 60.9% of cases , while in men was confirmed in 39.3% of cases. The stages of the laryngeal cancer were similarly of high advancement for both the men and women - stages III and IV were confirmed in 82.6% of women and in 77.6% of men. The over 5-year survival rate was 39.1% among women and 37.2% among men. Conclusions Contradictory to decreased exposure to risk factors and the shorter period for diagnosis, the higher stages of cancer were observed in women. Although in women the advancement was higher and the majority of cases were located in unfavourable supraglottic area, the survival rates were higher. Key words: laryngeal cancer, epidemiology, men and women, risk factors
Background: Heart failure (HF) is a leading cause of poor outcome. Age is considered one of the most critical risk factors for both the incidence and prognosis of HF. Therefore we aimed to assess the predictors of poor prognosis in HF patients with particular attention to the elderly population. Material and methods: We retrospectively enrolled patients hospitalized due to HF exacerbation during 2016-2017 (203 patients). The end-points were all-cause mortality and emergency rehospitalizations within a two-year follow-up period. A detailed analysis was performed in the subgroups of patients younger and older than 65 years old. Results: 121 (60%) patients experienced the end-points. Age, low systolic blood pressure, NYHA class IV, right ventricle HF symptoms, high C-reactive protein, troponin, NT-proBNP, hyponatremia, catecholamine therapy and mechanical ventilation during hospitalization independently predicted the end-points. The elderly were characterized by a higher incidence of concomitant diseases and HF with moderately reduced or preserved LVEF, worse laboratory parameters and pharmacological treatment, as well as worse prognosis. Conclusion: The prognosis of patients hospitalized due to HF, mainly the elderly, is poor. Simple clinical parameters could be useful in further decision-making regarding the intensification of their treatment.
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