W. Wojciechowska, S. Surowiec, A. Olszanecka, A. Gawlewicz-Mroczka, K. Sładek, D. Czarnecka
901 tumor not enhanced by contrast media (diame‐ ter, 63 mm) in the posterior mediastinum. The tu‐ mor compressed the upper surface of the left atri‐ um and the inferior wall of the right pulmonary artery causing blood flow limitation. Additional‐ ly, enlargement of subcarinal, lower paratrache‐ al, and right hilar lymph nodes was diagnosed. At that time, inflammatory markers were with‐ in the reference range. In the thoracic surgery de‐ partment, after bronchoscopy and endobronchial A 33 ‐year ‐old man, not treated before, had a his‐ tory of one episode of atrial fibrillation (AF). A tumor behind the left atrium was revealed in a transthoracic echocardiogram (FIGURE 1A–C). The patient was admitted to the hospital, where a thoracic X ‐ray showed linear and nodular opac‐ ities in the superior segments of the upper lobes suggesting inactive tuberculosis. A thoracic com‐ puted tomography (CT) and magnetic resonance (MRI) were performed, and revealed a benign CLINICAL IMAGE
{"title":"Following the thread: an unexpected cause of atrial fibrillation.","authors":"W. Wojciechowska, S. Surowiec, A. Olszanecka, A. Gawlewicz-Mroczka, K. Sładek, D. Czarnecka","doi":"10.20452/pamw.3701","DOIUrl":"https://doi.org/10.20452/pamw.3701","url":null,"abstract":"901 tumor not enhanced by contrast media (diame‐ ter, 63 mm) in the posterior mediastinum. The tu‐ mor compressed the upper surface of the left atri‐ um and the inferior wall of the right pulmonary artery causing blood flow limitation. Additional‐ ly, enlargement of subcarinal, lower paratrache‐ al, and right hilar lymph nodes was diagnosed. At that time, inflammatory markers were with‐ in the reference range. In the thoracic surgery de‐ partment, after bronchoscopy and endobronchial A 33 ‐year ‐old man, not treated before, had a his‐ tory of one episode of atrial fibrillation (AF). A tumor behind the left atrium was revealed in a transthoracic echocardiogram (FIGURE 1A–C). The patient was admitted to the hospital, where a thoracic X ‐ray showed linear and nodular opac‐ ities in the superior segments of the upper lobes suggesting inactive tuberculosis. A thoracic com‐ puted tomography (CT) and magnetic resonance (MRI) were performed, and revealed a benign CLINICAL IMAGE","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"20 1","pages":"901-902"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84113822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Markers of autonomic nervous system impairment in celiac disease: we know the questions to ask but we still do not have answers.","authors":"G. Rydzewska","doi":"10.20452/pamw.3697","DOIUrl":"https://doi.org/10.20452/pamw.3697","url":null,"abstract":"","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"21 1","pages":"842-844"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84189486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Safety of long-‑acting β2-‑agonists: a little bit of history. Dr. Paul O'Byrne in an interview with Dr. Roman Jaeschke: part 1.","authors":"P. O'Byrne, R. Jaeschke","doi":"10.20452/pamw.3667","DOIUrl":"https://doi.org/10.20452/pamw.3667","url":null,"abstract":"","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"39 1","pages":"910-911"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76296223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Less is more: the dynamic epidemiology of cardiovascular diseases.","authors":"Y. Plakht, A. Shiyovich","doi":"10.20452/pamw.3695","DOIUrl":"https://doi.org/10.20452/pamw.3695","url":null,"abstract":"","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"44 1","pages":"839-841"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72637149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
925 New treatment options have come along the dis‐ covery of different tyrosine kinases and their cru‐ cial role in the pathogenesis of several cancers, in‐ cluding thyroid carcinoma. Multikinase inhibitors (MKIs) are a new group of drugs, recently widely in‐ vestigated in oncology. They show activity against receptors of different growth factors, leading to the inhibition of tumor cell growth and division. Thyroid cancer is the most common endocrine malignancy. According to the Polish National Can‐ cer Registry, it accounts for 0.5% and 2.6% of all neoplasms in men and women, respectively. The number of new cases of thyroid cancer has recently rapidly increased worldwide, mostly due to accurate and easily accessible thyroid sonogra‐ phy. In Poland, thyroid cancer was diagnosed in 314 patients in 1980, 448 patients in 1990, and as many as 2192 patients in 2010. The most common is differentiated thyroid cancer (DTC), diagnosed in nearly 94% of pa‐ tients (80%, papillary thyroid cancer [PTC] and 14%, follicular thyroid cancer [FTC]) and arising from follicular cells. Medullary thyroid carcino‐ ma (MTC), which develops from parafollicular C cells, accounts for 4% to 8% of all cases of thyroid cancer. In general, both DTC and MTC are char‐ acterized by good outcomes, with 10 ‐year over‐ all survival (OS) rates of 93%, 85%, and 75% for PTC, FTC, and MTC, respectively.1 Regardless of its good prognosis, approximate‐ ly 3% to 15% of DTC patients show disseminated disease at presentation,2,3 whereas DTC relapse may occur during decades in up to 30% of pa‐ tients.4 Surgery and/or radioiodine (RAI) thera‐ py are the main treatment options for recurrent DTC,5,6 as the majority of patients show the abil‐ ity of RAI uptake in cancer foci.7 However, one‐ ‐third of patients are refractory to RAI therapy. This group is characterized by much worse prog‐ nosis, with OS rates of about 10% at 10 years and 6% at 15 years.7 FORUM FOR INTERNAL MEDICINE
{"title":"An internist's approach to cancer diseases based on the model of thyroid cancer treated with tyrosine kinase inhibitors.","authors":"J. Krajewska, B. Jarzab","doi":"10.20452/pamw.3677","DOIUrl":"https://doi.org/10.20452/pamw.3677","url":null,"abstract":"925 New treatment options have come along the dis‐ covery of different tyrosine kinases and their cru‐ cial role in the pathogenesis of several cancers, in‐ cluding thyroid carcinoma. Multikinase inhibitors (MKIs) are a new group of drugs, recently widely in‐ vestigated in oncology. They show activity against receptors of different growth factors, leading to the inhibition of tumor cell growth and division. Thyroid cancer is the most common endocrine malignancy. According to the Polish National Can‐ cer Registry, it accounts for 0.5% and 2.6% of all neoplasms in men and women, respectively. The number of new cases of thyroid cancer has recently rapidly increased worldwide, mostly due to accurate and easily accessible thyroid sonogra‐ phy. In Poland, thyroid cancer was diagnosed in 314 patients in 1980, 448 patients in 1990, and as many as 2192 patients in 2010. The most common is differentiated thyroid cancer (DTC), diagnosed in nearly 94% of pa‐ tients (80%, papillary thyroid cancer [PTC] and 14%, follicular thyroid cancer [FTC]) and arising from follicular cells. Medullary thyroid carcino‐ ma (MTC), which develops from parafollicular C cells, accounts for 4% to 8% of all cases of thyroid cancer. In general, both DTC and MTC are char‐ acterized by good outcomes, with 10 ‐year over‐ all survival (OS) rates of 93%, 85%, and 75% for PTC, FTC, and MTC, respectively.1 Regardless of its good prognosis, approximate‐ ly 3% to 15% of DTC patients show disseminated disease at presentation,2,3 whereas DTC relapse may occur during decades in up to 30% of pa‐ tients.4 Surgery and/or radioiodine (RAI) thera‐ py are the main treatment options for recurrent DTC,5,6 as the majority of patients show the abil‐ ity of RAI uptake in cancer foci.7 However, one‐ ‐third of patients are refractory to RAI therapy. This group is characterized by much worse prog‐ nosis, with OS rates of about 10% at 10 years and 6% at 15 years.7 FORUM FOR INTERNAL MEDICINE","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"149 1","pages":"925-928"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86660957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
That was all there was. Now we have 12 class‐ es in the United States—in other countries it is about 10 or 11. That to me is wonderful; it means that we have choice and it means that we can tai‐ lor more the therapy to the individual patients that we have. Several of the drugs we have cause weight loss as a side effect: actually 2 of them, sodium ‐glucose cotransporter 2 (SGLT2) inhibi‐ tors and the glucagon ‐like peptide (GLP)‐1 recep‐ tor agonists do have a weight loss effect. Many of the drugs do not cause hypoglycemia and very few cause weight gain now. The only drugs that cause a little bit of weight gain are sulfonylureas and insulin, and thiazolidinediones, which are not used that often today. I think most people would not argue that unless there was a contra‐ indication or people could not tolerate the drug, people today should probably be taking metfor‐ min as an agent for diabetes for lots of reasons, including its long safety record, the fact that it may be associated with a lower risk of cardiovas‐ cular events and other outcomes, and that it has really proven itself over the years. After that, I think it depends on how hyper‐ glycemic the patient is and what their comorbidi‐ ties are. If they have renal failure, you cannot use many drugs; if they have a very low glomerular filtration rate (GFR), insulin is probably the only safe drug to use for people with a low GFR. If they are very hyperglycemic, you are probably wise to start with insulin right away or in addition to met‐ formin because you have to lower their blood glu‐ cose levels and get them down quickly; if they are at high cardiovascular risk, I think empagliflozin is a reasonable drug. If weight loss is an impor‐ tant criterion, then one can consider GLP ‐1 recep‐ tor agonist plus empagliflozin. If they had previ‐ ous pancreatitis, then you would not want to use the drugs that have concerns about pancreatitis, like the incretins‐ipeptidyl peptidase ‐4 (DPP ‐4) inhibitors. So I guess I do not have an easy an‐ swer for the question. There are also issues of In a previous interview,1 you told us about empagliflozin. How about the other classes of drugs used in the treatment of type 2 diabetes? Which one would you say we use—I do not know whether it could be said—routinely, regularly? I know already that there is no such thing as an average patient.
{"title":"Drugs in diabetes in 2016, changes in endocrinology in 2015. Dr. Hertzel Gerstein in an interview with Dr. Roman Jaeschke.","authors":"H. Gerstein, R. Jaeschke","doi":"10.20452/pamw.3663","DOIUrl":"https://doi.org/10.20452/pamw.3663","url":null,"abstract":"That was all there was. Now we have 12 class‐ es in the United States—in other countries it is about 10 or 11. That to me is wonderful; it means that we have choice and it means that we can tai‐ lor more the therapy to the individual patients that we have. Several of the drugs we have cause weight loss as a side effect: actually 2 of them, sodium ‐glucose cotransporter 2 (SGLT2) inhibi‐ tors and the glucagon ‐like peptide (GLP)‐1 recep‐ tor agonists do have a weight loss effect. Many of the drugs do not cause hypoglycemia and very few cause weight gain now. The only drugs that cause a little bit of weight gain are sulfonylureas and insulin, and thiazolidinediones, which are not used that often today. I think most people would not argue that unless there was a contra‐ indication or people could not tolerate the drug, people today should probably be taking metfor‐ min as an agent for diabetes for lots of reasons, including its long safety record, the fact that it may be associated with a lower risk of cardiovas‐ cular events and other outcomes, and that it has really proven itself over the years. After that, I think it depends on how hyper‐ glycemic the patient is and what their comorbidi‐ ties are. If they have renal failure, you cannot use many drugs; if they have a very low glomerular filtration rate (GFR), insulin is probably the only safe drug to use for people with a low GFR. If they are very hyperglycemic, you are probably wise to start with insulin right away or in addition to met‐ formin because you have to lower their blood glu‐ cose levels and get them down quickly; if they are at high cardiovascular risk, I think empagliflozin is a reasonable drug. If weight loss is an impor‐ tant criterion, then one can consider GLP ‐1 recep‐ tor agonist plus empagliflozin. If they had previ‐ ous pancreatitis, then you would not want to use the drugs that have concerns about pancreatitis, like the incretins‐ipeptidyl peptidase ‐4 (DPP ‐4) inhibitors. So I guess I do not have an easy an‐ swer for the question. There are also issues of In a previous interview,1 you told us about empagliflozin. How about the other classes of drugs used in the treatment of type 2 diabetes? Which one would you say we use—I do not know whether it could be said—routinely, regularly? I know already that there is no such thing as an average patient.","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"61 6 1","pages":"907-908"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85054136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Basophil activation test in allergic rhinitis. Authors' reply.","authors":"Małgorzata Leśniak, M. Mazur, E. Czarnobilska","doi":"10.20452/pamw.3705","DOIUrl":"https://doi.org/10.20452/pamw.3705","url":null,"abstract":"","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"238 1","pages":"904"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73643821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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