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.
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.
Non-Hodgkin lymphomas (NHL) comprise a heterogeneous group of B-cell and T-cell neoplasms. Diffuse large B-cell lymphoma (DLBCL), the most common type of NHL, accounts for around 30-40% of NHL cases. However, primary hepatic location of NHLs is rare and constitutes 0.01% of all NHL cases. Due to this rarity and a lack of large randomized trails, it is still unclear what treatment should be used for primary hepatic DLBCLs. In this study, we report of a female patient with primary hepatic DLBCL who was successfully treated with neoadjuvant chemotherapy and surgery. We also shortly review the literature regarding surgical treatments for primary GI tract NHLs. Taking into account our experience and the current literature, surgical treatment with postoperative chemotherapy seems to be a feasible option for patients with focal primary hepatic DLBCLs.
Allergic rhinitis (AR) affects both the quality of life and daily functioning of a patient. Carefully selected personalized therapy determines good management of disease symptoms. In the latest update of the ARIA (Allergic Rhinitis and its Impact on Asthma) guidelines, the algorithm for therapeutic management is based on the assessment of a patient’s condition with the use of a Visual Analogue Scale (VAS), therefore adopting an approach which involves either escalation (step up) or reduction (step down) of treatment. First-line drugs include: second-generation antihistamines, intranasal corticosteroids (INCS) and a combination of INCS with azelastine. Since the combination of INCS with intranasal H1 antihistamine drugs allows patients to benefit from therapeutic advantages of both drug categories, it is considered to be a universal treatment strategy. The combination of mometasone furoate with olopatadine hydrochloride is the latest therapeutic option in this drug category. These drugs prove highly effective and demonstrate a favorable safety profile.
Improving the effectiveness of the treatment of critically ill and their longer survival has increased the existence of later complications rarely seen before. Among the hospital-acquired infections such complications include infection of mold fungi. The paper presents difficulties in diagnosing and therapy of Aspergillus mold infections illustrating them with the description of cases when Aspergillus infection occurred during the treatment of critically ill, leading with treatment delay to high mortality.
Travel to developing countries is associated with possibility to acquire different, also parasitic, diseases which have become a diagnostic and therapeutic problem. The ENT specialist is one of the medical officers who may make initial contact with a patient with a suspected parasitic disease. One of them is leishmaniosis: a parasitic disease classified as Neglected Tropical Diseases (NTD), which occurs in the tropics, subtropics and southern Europe. While asymptomatic invasion is observed in some cases, three forms of symptomatic leishmaniosis can be distinguished: cutaneous leishmaniosis (CL), visceral leishmaniosis (VL), and mucosal leishmaniosis (ML). Signs and symptoms of these forms, as well as the differential diagnosis, diagnostic procedures and treatment are presented in the paper.
ELOS technology uses a simultaneous activity of a semi-conductor laser light and bipolar current of high radiofrequency (RF). The laser energy is absorbed by hemoglobin in the dilated vessels through a selective photothermolysis. Energy of the radiofrequency current, conducted through the skin, heats the vessel up until it reaches the temperature which destroys it. This technology is the basis of safe and effective ablation of small vascular lesions up to 4 mm in diameter.The aim of the study was evaluation of treatment results with application of a combined percutaneous technique using synergistic RF frequency activity and a diode laser.Material and methods. One -hundred and fifty women ages 23 to 68 years (mean=41.1) qualified for the treatment. None of the patients had a history of deep venous insufficiency. Electro-optical synergy (ELOS) technology was used as a treatment approach. The time for the procedure ranged from 10 to 30 minutes (average=18 min.). Treatment results were evaluated after 30 days using both a four-point medical evaluation scale and a four-point subjective assessment-of-satisfaction scale. The degree of pain accompanying the procedure was also determined.Results. In a medical evaluation, after all procedures were complete, 102 very good results were obtained (68%) and we did not succeed in 48 cases (32%). In a subjective evaluation, 120 (80%) very good or good and 25 (16.6%) unsatisfactory assessments were obtained. The results of the treatment were assessed as satisfactory by 5 patients (3.4%).Conclusions. 1. The ELOS technique is an efficient and safe method of telangiectasia treatment. 2, The ELOS technique gives a high percentage of good and very good treatment results, both in medical evaluations and patients' subjective assessments.
Pilomatrixoma (PMT), or calcifying epithelioma Mahlerbego, is relatively rare ectodermal origin cancer derived from cells of the hair matrix. Calcifying epithelioma usually presents itself as a single, hard, movable relative to the skin and substrate lump about the size of 1–5 cm. The overlying skin is often bluish tinted. Usually asymptomatic, but can be painful in case of ulcers or inflammation. Most pilomatrixoma does not cause clinical complications. The clinical course is usually mild, but are noted malignant transformation, especially in old age. In this case the cancer metastases are in the lungs, bone, brain, skin. There is also a malignant form called – pilomatix carcinoma. The differential diagnosis should include tumors of the parotid gland, cancer of the skin, foreign body reactions, hematoma, osteochondroma. The authors present a case of changing parotid right preauricular area in a 47-year-old patient, change mezofitic with central ulceration and leakage of the contents muco-purulent. After downloading the wedge-shaped slice and after verification histopathological pilomaxitroma
Invasive fungal infections (IFI) are one of the most severe complications of treatment in patients with acute myeloid leukaemia (AML) that are diagnosed during the myelosuppression period following intensive chemotherapy. Due to a high mortality rate reaching up to 30–70%, IFI require an adequate prevention, and once an active infection is diagnosed – a rapid diagnosis and an effective antifungal therapy. Modern therapy models are based on expensive treatment regimens and are often associated with long-term hospitalization and the need for intensive supportive treatment.
Fungi, in comparison with other pathogenic factors, have high pathogenecity. The number of fungal species which are able to infect people is over 500. The upper respiratory tract and ear have permanent contact with external environment which makes their ontocenoses open to continuous exchange of microorganisms of which they consist. In etiology of inflammatory processes 21 species which belonging to 3 genera (Zygomycota, Asomycota, Basidiomycota) of fungi play important role. Administration of antifungal drugs can be: prophylactic, empiric preemptive and therapeutic. Physicians may prescribe antibiotics (mainly poliens: amphotericin B, natamycin and nystatin) and chemiotherapeutics (mainly azoles and fluorpirymidins, pigments, chlorhexidine and chlorquinaldol). In ENT practice topical and systemic drugs can be administrated. Topical lozenges include amphotericin B, clotrimazole, chlorhexidine or chlorquinaldol and oral gels: nystatin and miconazole. Some of drugs are in the form of suspension/solution, which can be used for inhalation, into the sinus, for swabbing or for lavage: amphotericin B, natamycin, nystatin, clotrimazol, flucytosine, miconazole, fluconazole, vorykonazole, caspofungin. It should be underlined that only a few of dugs can be absorbed from the digestive tract: flucytosine, fluconazole, itraconazole, ketoconazole, miconazole, vorykonazole.
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.
Background: World Health Organization considers obesity as the most serious health condition in the world today. This concerns not only adults but also children and young people. Obesity is the leading cause of increased morbidity, disabilities, mortality rates and deteriorated quality of life in society. Higher death risk due to cardiovascular diseases and certain cancerous conditions are also attributable to obesity. Some 40% adults in the world today are overweight and 13% are obese. These tendencies have also been observed in Poland. Specific components of comprehensive slimming treatments include dietary treatment, nutrition education, habits modification, increased level of physical activity, pharmacological treatment and surgical interventions. The basis in obesity treatment is to induce a negative energy balance. This status is typically achieved through dietary measures and increased energy expenditure. Helping prepare adequate individual therapeutic programs is a key to success in slimming of the obese patients. Mass reduction programs are prepared individually based on FITT formula, which takes into consideration four aspects of physical activity: frequency, intensity, time and type of physical activity. The role of physiotherapists in this process is essential. Individual therapeutic programs help adjust all the aspects of training to the health status of the obese patients, with respect to coexisting diseases.
The eating disorder that generates the highest death rate is that of anorexia nervosa, and current treatment is a combination of equalization of somatic state and patient education. Moreover, psychical symptoms occurring in the course of anorexia nervosa are thought to have a crucial influence on the course of the disease. Hence, in medical literature, the effectiveness of psychotherapeutic interventions is also widely described. Still, the implementation of appropriate psychopharmacology is now considered an additional method of treatment, rather than a therapy of choice. Yet, in spite of many years of research, there are no absolute recommendations given, nor are instructions within the scope of psychopharmacological treatment proffered, although the selection of psychopharmacological items must respect both the patient’s psychic and somatic states. In recent years, the popularity of psychopharmacological treatment has increased; therefore, we feel that it is justified to present the latest scientific information in this respect.
When compared with other EU countries, Poland is in the last place in terms of efficacy of rectal cancer treatment. In order to remedy this situation, in 2008 Polish centres were given the opportunity to participate in an international programme for evaluating the treatment efficacy.The aim of the study was to present the results obtained during the first two years of research.Material and methods. The study protocol covered 71 questions concerning demographic data, diagnostics, risk factors, peri- and post-operative complications, histopathology, and treatment plan at discharge. The patient and unit data were kept confidential.Results. From 1 January 2008 to 30 December 2009, there were 709 patients recorded, of which 55.9% were males. At least one risk factor was found in approx. 3/4 of patients, while approx. 1/3 of patients were classified to group 3 and 4 according to ASA. The mean distance of the tumour from the anal margin was 8.5 cm; approx. 70% of patients were in the clinical stages cT3 and cT4; metastases were observed in 18.8%. Transrectal endoscopic ultrasonography (TREUS) was performed in 23.7% of patients, magnetic resonance imaging (MRI) in 2.5% and computed tomography (CT) scan - in 48.1%. In close to half of the patients, anterior or low anterior resection of the rectum was performed, and abdominoperineal resection in 1/4 of the patients. Anastomotic leakage was seen in 3.8% of patients, while 1.8% died during hospitalisation.Conclusions. It should be strived after that all the centres undertaking the treatment of rectal cancer should participate in the quality assurance programme. This should enable the achievement of good therapeutic results in patients with rectal cancer treated in Polish centres.
INTRODUCTION: Cardiovascular diseases, including coronary disease and its complications, are the most common cause of death. Myocardial infarction is usually caused by a blood clot cosing the lumen of a coronary artery at the site of an unstable atherosclerotic plaque. MATERIAL AND METHODS: All the analyzed patients with mechanical complications of acute myocardial infarction (AMI) were hospitalized at the 2nd Department of Cardiology and Department of Anaesthesiology and Intensive Care of the Upper-Silesian Medical Centre in Katowice in 2006–2016 and the database was based on the medical records of the patients. The study group comprised 52 (100%) patients. There were 23 (44.2%) women and 29 (55.8%) men, aged 54 to 84 years with a mean age of 69.8 years. RESULTS: Ventricular septal rupture (n = 36; 69.2%) was the most frequently observed complication but papillary muscle rupture (n = 4; 7.7%) and tendinous chord rupture (n = 4; 7.7%) were the least frequent. Hypertension and hypercholesterolemia were the most common risk factors for coronary heart disease in the study group. An increased mortality rate was observed in patients who received pharmacological treatment compared to surgically treated patients (87.5% vs. 61.4%). The majority of patients had one risk factor for coronary heart disease (28; 53.8%). CONCLUSIONS: 1. In the study group, ventricular septal rupture and the cardiac free wall rupture were the most frequently observed mechanical complications of AMI. 2. Patients with AMI had numerous risk factors for coronary heart disease, of which hypertension and hypercholesterolemia were the most common. 3. Patients with mechanical complications of AMI had both higher mortality rates than survival and they were higher in the pharmacologically treated group.
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WSTĘP: Choroby układu krążenia, w tym choroba wieńcowa i jej powikłania, stanowią najczęstszą przyczynę zgonów. Zawał mięśnia sercowego spowodowany jest zwykle pęknięciem blaszki miażdżycowej i zamknięciem tętnicy wieńcowej skrzepliną. MATERIAŁ I METODY: Badaniem objęto 52 chorych (100%) z mechanicznymi powikłaniami ostrego zawału serca, hospitalizowanych w II Oddziale Kardiologii oraz Oddziale Anestezjologii i Intensywnej Terapii Górnośląskiego Centrum Medycznego w Katowicach w latach 2006–2016, wtym 23 kobiety (44,2%) i 29 mężczyzn (55,8%) w wieku 54‒84 lat (średnia wieku 69,8 roku). WYNIKI: Najczęstszym powikłaniem było pęknięcie przegrody międzykomorowej (n = 36; 69,2%), natomiast do najrzadszych należały pęknięcie mięśnia brodawkowatego (n = 4; 7,7%) i pęknięcie ścięgien (n = 4; 7,7%). Nadciśnienie i hipercholesterolemia były najczęstszymi czynnikami ryzyka wystąpienia choroby niedokrwiennej serca w badanej grupie. Zwiększoną śmiertelność zaobserwowano u pacjentów leczonych farmakologicznie (87,5%), podczas gdy śmiertelność pacjentów leczonych operacyjnie wynosiła 61,4%. U większości pacjentów występował jeden czynnik ryzyka choroby wieńcowej (n = 28; 53,8%). WNIOSKI: 1. Najczęstszymi powikłaniami były pęknięcie przegrody międzykomorowej i pęknięcie ściany serca. 2. U pacjentów występowało wiele czynników ryzyka dla choroby niedokrwiennej serca, spośród których najczęstszymi były nadciśnienie i hipercholesterolemia. 3. Śmiertelność w badanej grupie chorych z mechanicznymi powikłaniami ostrego zawału serca znacznie przewyższała przeżywalność i była większa w grupie leczonych zachowawczo.
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.
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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.
Balneology (from Lat.: balneum - Steam, with gr,: lógos - science) the field of medicine spa known since antiquity that studies the healing properties of groundwater and mud, and using them in therapy. Balneology is especially effective treatment of chronic diseases such as rheumatoid arthritis, osteoarthritis and spine, post-traumatic and post-operative orthopedic osteoarthritis, gout, osteoporosis, coronary heart disease, post myocardial infarction, post alular and vascular diseases, hypertension, diseases of the nervous system and respiratory system. One of the most beautifully situated and rich in water treatment is a spa town in Dlugopole
Introduction: The aim of the study was to present selected cases with Eagle’s syndrome diagnosed and treated at the Department of Otolaryngology, Laryngological Oncology, Audiology and Phoniatrics, Medical University of Lodz, in the years 2016–2020. Material and method: Five selected clinical cases with Eagle’s syndrome are presented, including three male patients and two female patients, aged 28 to 42 years. Results: The prevalence of Eagle’s syndrome was similar for both female and male patients. The carotid artery syndrome, which is characterized by: visual disturbances, unilateral pain located along cervical vessels, headache and migraine, was more common. Lack of proper diagnosis of Eagle’s syndrome often significantly delays the implementation of proper treatment and thus exposes patients to long-term struggle with pain. Our observations have shown that the time between the onset of symptoms and correct diagnosis in patients averaged about five years. 3D-CT scan is the gold standard for detecting Eagle’s syndrome. An intraoral approach was used in surgical treatment. Although this approach offers shorter treatment time and better cosmetic effect, there is also a greater risk of complications associated with limited visibility of the surgical field and infection. Conclusions: Although styloid syndrome usually occurs bilaterally, these patients reported unilateral symptoms. No correlations were found between the prevalence of Eagle’s syndrome and sex, the length of the styloid process or age, nor side of the body. The best healing effect is obtained by surgical correction/reduction of the elongated styloid process.
Aim: Aim of the study was retrospective analysis of the patients documentation treated for acute mastoiditis (AM) in Department of Pediatric Otolaryngology in Bialystok and available literature on this subject to determine the optimal rules of treatment in AM. Material and methods: A retrospective analysis of 40 patients treated for AM in 2001-2017. We have adopted Anthonsen et al. [15] AM diagnosis criteria to include patients to this study. Results: The mean age of the respondents was 46 months, 37% of children were less than 2 years old. 2/3 of the cases were not preceded by previous acute otitis media(AOM) episodes. 69% of patients received antibiotics before admission to the hospital. In laboratory studies, 95% of patients had elevated indices of inflammation (CRP, leukocytosis), and their value was higher among patients qualified for surgery. The indications for computed tomography (CT) were the lack of improvement after conservative treatment for 48 hours or symptoms of the presence of subperiosteal abscess. CT was performed in 35% of patients. 24 patients (60%) were treated only conservatively: myringotomy without / with the insertion of a ventilation tubes and intravenous antibiotic therapy. The most commonly used antibiotic was ceftriaxone - 75% of patients. 16 patients required mastoidectomy. The most common indication (30%) for mastoidectomy was the presence of subperiosteal abscess. Conclusion: In uncomplicated AM cases CT does not have to be routinely performed, a myringotomy should be performed with or without drains insertion and an empiric intravenous antibiotic therapy should be started. In presence of a subperiosteal abscess, it is recommended to perform CT with contrast and mastoidectomy. Deterioration of the patient's condition or lack of improvement after 48 hours of conservative treatment obliges us to make a CT and on the basis of the decision on mastoidectomy.
Breast cancer is the most frequently diagnosed female cancer in Poland (over 17,500 women). Anthracyclines have become one of the most important drugs in breast cancer systemic treatment. In the treatment of metastatic disease combination chemotherapy with doxorubicin provides the objective response rate of 60–85%, and the median time of progression-free survival is about 12 months. Non-pegylated liposomal doxorubicin (NPLD) in combination with cyclophosphamide is associated with a lower risk of cardiotoxicity, higher efficacy and more favourable toxicity profile as compared with conventional anthracycline regimes. Two cases of females patients treated with NPLD described in this article demonstrate the importance of the choice of chemotherapy, professional monitoring, early detection and treatment of adverse effects. Non-pegylated liposomal doxorubicin ordained in systemic treatment of stage IV breast cancer prolongs survival and enhances the quality of life. It is a reasonable option for palliative therapy.
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