Aleksander Siniarski, P. Rostoff, B. Laskowicz, Radosław Rychlak, J. Nessler, G. Gajos
899 from the right or left anterior descending cor‐ onary artery; therefore, Cx fistulas are unique. A great majority of fistulas bypass the blood from the arterial to venous systems, such as the pulmo‐ nary artery, coronary sinus, superior vena cava, or right ‐sided heart chambers. Most patients re‐ main asymptomatic.1 Possible clinical presenta‐ tions of coronary fistulas include angina, myocar‐ dial infarction, heart failure symptoms, endocar‐ ditis, arrhythmias, and they are related with the size and location of a fistula.3 Of note, most pa‐ tients develop symptoms of myocardial ischemia in their fourth to sixth decade of life.4 Myocardi‐ al ischemia associated with coronary fistulas can be secondary or, less common, primary.4 Coronary steal syndrome was a possible expla‐ nation of angina in our patient. Potential compli‐ cations of coronary fistulas are aneurysmal remod‐ eling of drained artery, which was present in our patient, and rupture or thrombosis of the fistula. Coronary angiography is the gold standard for di‐ agnosing coronary fistula.1 Nevertheless, nonin‐ vasive methods such as color ‐flow Doppler ultra‐ sound, magnetic resonance imaging, and comput‐ ed tomography can be useful in diagnosis, as they show the exact shape and anatomy of arteriove‐ nous connections of fistulas.5 Treatment is recom‐ mended only for symptomatic patients, and pos‐ sible options are surgical or transcatheter fistula closure. Surgical treatment was the most common technique until the introduction of transcatheter techniques in carefully selected patients with suit‐ able anatomy of the fistula, namely, accessible with a closure device and with no other indications for surgery.1 Coronary artery fistulas, although rare, should be considered in a differential diagnosis of chest pain, particularly in young patients without known risk factors of atherosclerosis. A 61 ‐year ‐old Caucasian woman with a history of ischemic heart disease, hypertension, type 2 dia‐ betes, and hypercholesterolemia was admitted to the hospital due to unstable angina. Three months prior to hospitalization, an exercise treadmill test was performed showing a significant down sloping ST ‐segment depression of 1.5 mm in leads III, aVF, and V4–V6, at 7 metabolic equivalents of exercise with no chest pain. A physical examination was unremarkable, blood pressure was 130/75 mmHg, and the pulse rate was regular (66 bpm). An elec‐ trocardiogram on admission revealed inferolat‐ eral ST ‐segment depression with ST ‐segment el‐ evation in lead aVR, suggesting diffuse subendo‐ cardial ischemia. Routine blood test results were normal. The measurement of high ‐sensitivity car‐ diac troponin levels yielded negative results. Ur‐ gent transthoracic echocardiography showed no wall motion abnormalities with normal left ven‐ tricular ejection fraction of 65%. On a comput‐ ed tomography (CT) angiography, a fistula from the circumflex artery (Cx) to coronary sinus was suspected (FIGURE 1A–C). The coronary an
{"title":"Left circumflex coronary artery aneurysm with arteriovenous fistula to the coronary sinus presenting as acute coronary syndrome.","authors":"Aleksander Siniarski, P. Rostoff, B. Laskowicz, Radosław Rychlak, J. Nessler, G. Gajos","doi":"10.20452/pamw.3658","DOIUrl":"https://doi.org/10.20452/pamw.3658","url":null,"abstract":"899 from the right or left anterior descending cor‐ onary artery; therefore, Cx fistulas are unique. A great majority of fistulas bypass the blood from the arterial to venous systems, such as the pulmo‐ nary artery, coronary sinus, superior vena cava, or right ‐sided heart chambers. Most patients re‐ main asymptomatic.1 Possible clinical presenta‐ tions of coronary fistulas include angina, myocar‐ dial infarction, heart failure symptoms, endocar‐ ditis, arrhythmias, and they are related with the size and location of a fistula.3 Of note, most pa‐ tients develop symptoms of myocardial ischemia in their fourth to sixth decade of life.4 Myocardi‐ al ischemia associated with coronary fistulas can be secondary or, less common, primary.4 Coronary steal syndrome was a possible expla‐ nation of angina in our patient. Potential compli‐ cations of coronary fistulas are aneurysmal remod‐ eling of drained artery, which was present in our patient, and rupture or thrombosis of the fistula. Coronary angiography is the gold standard for di‐ agnosing coronary fistula.1 Nevertheless, nonin‐ vasive methods such as color ‐flow Doppler ultra‐ sound, magnetic resonance imaging, and comput‐ ed tomography can be useful in diagnosis, as they show the exact shape and anatomy of arteriove‐ nous connections of fistulas.5 Treatment is recom‐ mended only for symptomatic patients, and pos‐ sible options are surgical or transcatheter fistula closure. Surgical treatment was the most common technique until the introduction of transcatheter techniques in carefully selected patients with suit‐ able anatomy of the fistula, namely, accessible with a closure device and with no other indications for surgery.1 Coronary artery fistulas, although rare, should be considered in a differential diagnosis of chest pain, particularly in young patients without known risk factors of atherosclerosis. A 61 ‐year ‐old Caucasian woman with a history of ischemic heart disease, hypertension, type 2 dia‐ betes, and hypercholesterolemia was admitted to the hospital due to unstable angina. Three months prior to hospitalization, an exercise treadmill test was performed showing a significant down sloping ST ‐segment depression of 1.5 mm in leads III, aVF, and V4–V6, at 7 metabolic equivalents of exercise with no chest pain. A physical examination was unremarkable, blood pressure was 130/75 mmHg, and the pulse rate was regular (66 bpm). An elec‐ trocardiogram on admission revealed inferolat‐ eral ST ‐segment depression with ST ‐segment el‐ evation in lead aVR, suggesting diffuse subendo‐ cardial ischemia. Routine blood test results were normal. The measurement of high ‐sensitivity car‐ diac troponin levels yielded negative results. Ur‐ gent transthoracic echocardiography showed no wall motion abnormalities with normal left ven‐ tricular ejection fraction of 65%. On a comput‐ ed tomography (CT) angiography, a fistula from the circumflex artery (Cx) to coronary sinus was suspected (FIGURE 1A–C). The coronary an","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"10 1","pages":"899-900"},"PeriodicalIF":0.0,"publicationDate":"2016-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82020501","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}
Marta Domżalska, Z. Zdrojewski, N. Buda, A. Masiak, J. Szade, G. Romanowicz
{"title":"Symptoms mimicking Sjögren syndrome in a heterozygous carrier of CFTR deltaF508 mutation.","authors":"Marta Domżalska, Z. Zdrojewski, N. Buda, A. Masiak, J. Szade, G. Romanowicz","doi":"10.20452/pamw.3654","DOIUrl":"https://doi.org/10.20452/pamw.3654","url":null,"abstract":"","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"13 14","pages":"895-896"},"PeriodicalIF":0.0,"publicationDate":"2016-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91447152","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":"Electronic cigarettes: a new challenge for Polish public health.","authors":"Jakub Łobaszewski, J. Didkowska","doi":"10.20452/pamw.3652","DOIUrl":"https://doi.org/10.20452/pamw.3652","url":null,"abstract":"","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"21 1","pages":"905-906"},"PeriodicalIF":0.0,"publicationDate":"2016-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84533164","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}
A. Araszkiewicz, A. Gandecka, M. Nowicki, A. Uruska, A. Malińska, K. Kowalska, B. Wierusz-Wysocka, D. Zozulinska-Ziolkiewicz
INTRODUCTION Advanced glycation end products (AGEs) play a crucial role in the pathogenesis of diabetic peripheral neuropathy (DPN). OBJECTIVES The aim of the study was to assess the skin accumulation of AGEs in patients with long‑lasting type 1 diabetes in relation to the presence of DPN. PATIENTS AND METHODS We evaluated 178 patients with type 1 diabetes (99 men; age, 43 years [interquartile range [IQR], 34-54 years]; disease duration, 25 years [IQR, 18-31 years]). DPN was diagnosed if 2 or more of the following 5 abnormalities were present: symptoms of neuropathy, lack of ankle reflexes, and impaired sensation of touch, temperature, and/or vibration. PGP 9.5‑immunoreactive nerve fibers were counted to assess intraepidermal nerve fiber density (IENFD) in skin biopsy. The accumulation of AGEs in the skin was assessed on the basis of skin autofluorescence (AF). RESULTS Patients with DPN (45%), compared with those without neuropathy, had higher skin AF (2.6 AU [IQR, 2.3-3.1 AU] vs 2.1 AU [IQR, 1.8-2.5 AU]; P <0.001) and lower IENFD (10 fibers/mm [IQR, 7-14 fibers/mm] vs 12 fibers/mm [IQR, 8-16 fibers/mm]; P = 0.005). We found a positive correlation between skin AF and patients' age (Rs = 0.44; P <0.001), diabetes duration (Rs = 0.32; P <0.001), and a negative correlation between skin AF and the estimated glomerular filtration rate (Rs = -0.26, P <0.001) and IENFD (Rs = -0.22; P = 0.004). In a multiple linear regression analysis, skin AF was independently associated with age (β = 0.45; P <0.001), glycated hemoglobin level (β = 0.19; P = 0.007), and IENFD (β = - 0.14; P = 0.04) (R2 = 0.27; P <0.001). In multivariate logistic regression, the presence of DPN was independently associated with skin AF (odds ratio, 4.16; 95% confidence interval, 1.88-9.20; P <0.001). CONCLUSIONS The presence of DPN, and particularly small fiber neuropathy, is associated with a higher accumulation of AGEs in the skin of patients with type 1 diabetes.
{"title":"Association between small fiber neuropathy and higher skin accumulation of advanced glycation end products in patients with type 1 diabetes.","authors":"A. Araszkiewicz, A. Gandecka, M. Nowicki, A. Uruska, A. Malińska, K. Kowalska, B. Wierusz-Wysocka, D. Zozulinska-Ziolkiewicz","doi":"10.20452/pamw.3649","DOIUrl":"https://doi.org/10.20452/pamw.3649","url":null,"abstract":"INTRODUCTION Advanced glycation end products (AGEs) play a crucial role in the pathogenesis of diabetic peripheral neuropathy (DPN). OBJECTIVES The aim of the study was to assess the skin accumulation of AGEs in patients with long‑lasting type 1 diabetes in relation to the presence of DPN. PATIENTS AND METHODS We evaluated 178 patients with type 1 diabetes (99 men; age, 43 years [interquartile range [IQR], 34-54 years]; disease duration, 25 years [IQR, 18-31 years]). DPN was diagnosed if 2 or more of the following 5 abnormalities were present: symptoms of neuropathy, lack of ankle reflexes, and impaired sensation of touch, temperature, and/or vibration. PGP 9.5‑immunoreactive nerve fibers were counted to assess intraepidermal nerve fiber density (IENFD) in skin biopsy. The accumulation of AGEs in the skin was assessed on the basis of skin autofluorescence (AF). RESULTS Patients with DPN (45%), compared with those without neuropathy, had higher skin AF (2.6 AU [IQR, 2.3-3.1 AU] vs 2.1 AU [IQR, 1.8-2.5 AU]; P <0.001) and lower IENFD (10 fibers/mm [IQR, 7-14 fibers/mm] vs 12 fibers/mm [IQR, 8-16 fibers/mm]; P = 0.005). We found a positive correlation between skin AF and patients' age (Rs = 0.44; P <0.001), diabetes duration (Rs = 0.32; P <0.001), and a negative correlation between skin AF and the estimated glomerular filtration rate (Rs = -0.26, P <0.001) and IENFD (Rs = -0.22; P = 0.004). In a multiple linear regression analysis, skin AF was independently associated with age (β = 0.45; P <0.001), glycated hemoglobin level (β = 0.19; P = 0.007), and IENFD (β = - 0.14; P = 0.04) (R2 = 0.27; P <0.001). In multivariate logistic regression, the presence of DPN was independently associated with skin AF (odds ratio, 4.16; 95% confidence interval, 1.88-9.20; P <0.001). CONCLUSIONS The presence of DPN, and particularly small fiber neuropathy, is associated with a higher accumulation of AGEs in the skin of patients with type 1 diabetes.","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"11 1","pages":"847-853"},"PeriodicalIF":0.0,"publicationDate":"2016-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78780205","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}
Humans, like other species that reproduce sexually, originate from a fertilized oocyte (zygote), which is a totipotent stem cell giving rise to an adult organism. During the process of embryogenesis, stem cells at different levels of the developmental hierarchy establish all 3 germ layers and give rise to tissue‑committed stem cells, which are responsible for rejuvenation of a given tissue or organ. The robustness of the stem cell compartment is one of the major factors that directly impact life quality as well as lifespan. Stem cells continuously replace cells and tissues that are used up during life; however, this replacement occurs at a different pace in various organs. The rapidly developing field of regenerative medicine is taking advantage of these physiological properties of stem cells and is attempting to employ them in clinical settings to regenerate damaged organs (eg, the heart, liver or bone). For this purpose, the stem cells most successfully employed so far are adult tissue-derived stem cells isolated mainly from bone marrow, mobilized peripheral blood, umbilical cord blood, fat tissue, and even myocardial biopsies. At the same time, attempts to employ embryonic stem cells and induced pluripotent stem cells in the clinic have failed due to their genomic instability and the risk of tumor formation. In this review, we will discuss the various potential sources of stem cells that are currently employed in regenerative medicine and the mechanisms that explain their beneficial effects. We will also highlight the preliminary results of clinical trials as well as the emerging problems relating to stem cell therapies in cardiology.
{"title":"Stem cells and clinical practice: new advances and challenges at the time of emerging problems with induced pluripotent stem cell therapies.","authors":"M. Ratajczak, K. Bujko, W. Wojakowski","doi":"10.20452/pamw.3644","DOIUrl":"https://doi.org/10.20452/pamw.3644","url":null,"abstract":"Humans, like other species that reproduce sexually, originate from a fertilized oocyte (zygote), which is a totipotent stem cell giving rise to an adult organism. During the process of embryogenesis, stem cells at different levels of the developmental hierarchy establish all 3 germ layers and give rise to tissue‑committed stem cells, which are responsible for rejuvenation of a given tissue or organ. The robustness of the stem cell compartment is one of the major factors that directly impact life quality as well as lifespan. Stem cells continuously replace cells and tissues that are used up during life; however, this replacement occurs at a different pace in various organs. The rapidly developing field of regenerative medicine is taking advantage of these physiological properties of stem cells and is attempting to employ them in clinical settings to regenerate damaged organs (eg, the heart, liver or bone). For this purpose, the stem cells most successfully employed so far are adult tissue-derived stem cells isolated mainly from bone marrow, mobilized peripheral blood, umbilical cord blood, fat tissue, and even myocardial biopsies. At the same time, attempts to employ embryonic stem cells and induced pluripotent stem cells in the clinic have failed due to their genomic instability and the risk of tumor formation. In this review, we will discuss the various potential sources of stem cells that are currently employed in regenerative medicine and the mechanisms that explain their beneficial effects. We will also highlight the preliminary results of clinical trials as well as the emerging problems relating to stem cell therapies in cardiology.","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"358 1","pages":"879-890"},"PeriodicalIF":0.0,"publicationDate":"2016-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76516263","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}
E. Radzikowska, I. Barańska, A. Sobczyńska‐Tomaszewska, E. Wiatr, K. Roszkowski-Śliż
{"title":"Familial pneumothoraces: Birt-Hogg-Dubé syndrome.","authors":"E. Radzikowska, I. Barańska, A. Sobczyńska‐Tomaszewska, E. Wiatr, K. Roszkowski-Śliż","doi":"10.20452/pamw.3646","DOIUrl":"https://doi.org/10.20452/pamw.3646","url":null,"abstract":"","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"47 1","pages":"897-898"},"PeriodicalIF":0.0,"publicationDate":"2016-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77084755","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":"Voice in the forum for internal medicine.","authors":"B. Rogala","doi":"10.20452/pamw.3689","DOIUrl":"https://doi.org/10.20452/pamw.3689","url":null,"abstract":"","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"16 1","pages":"943"},"PeriodicalIF":0.0,"publicationDate":"2016-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73596932","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":"Internal medicine through a scientist's eye.","authors":"F. Coceani","doi":"10.20452/pamw.3628","DOIUrl":"https://doi.org/10.20452/pamw.3628","url":null,"abstract":"","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"34 1","pages":"819-820"},"PeriodicalIF":0.0,"publicationDate":"2016-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74439712","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}
803 of coronary narrowing. These people were randomized to either placebo or a drug called empagliflozin, and they were actually randomized to 2 different doses of empagliflozin, either 10 mg or 25 mg. The primary analysis was to compare the placebo group to the combined both-doses group. The study continued for 3.1 years, patients were seen periodically, and as I said, it was a blinded study, so investigators were told to manage the patients’ blood pressure, lipids, and glucose levels to the best of their abilities, obviously unaware of the drug the people were taking. At the end of a median follow -up of 3.1 years, the study ended and the results were presented at the European diabetes meeting in September. They showed that people randomized to empagliflozin had a 14%—very significant—reduction in the composite outcome of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. Even more interesting and more striking was that there was a totally independent reduction in death from all causes as well as death from cardiovascular causes, and a 30% to 35% reduction additionally in death from heart failure with no major effect on myocardial infarction or stroke alone. This study is very unique in that it really showed a very clear benefit of this glucose-lowering drug on serious health outcomes.
{"title":"Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes mellitus. Dr. Hertzel Gerstein in an interview with Dr. Roman Jaeschke.","authors":"H. Gerstein, R. Jaeschke","doi":"10.20452/pamw.3612","DOIUrl":"https://doi.org/10.20452/pamw.3612","url":null,"abstract":"803 of coronary narrowing. These people were randomized to either placebo or a drug called empagliflozin, and they were actually randomized to 2 different doses of empagliflozin, either 10 mg or 25 mg. The primary analysis was to compare the placebo group to the combined both-doses group. The study continued for 3.1 years, patients were seen periodically, and as I said, it was a blinded study, so investigators were told to manage the patients’ blood pressure, lipids, and glucose levels to the best of their abilities, obviously unaware of the drug the people were taking. At the end of a median follow -up of 3.1 years, the study ended and the results were presented at the European diabetes meeting in September. They showed that people randomized to empagliflozin had a 14%—very significant—reduction in the composite outcome of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. Even more interesting and more striking was that there was a totally independent reduction in death from all causes as well as death from cardiovascular causes, and a 30% to 35% reduction additionally in death from heart failure with no major effect on myocardial infarction or stroke alone. This study is very unique in that it really showed a very clear benefit of this glucose-lowering drug on serious health outcomes.","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"4 1","pages":"803-805"},"PeriodicalIF":0.0,"publicationDate":"2016-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74895848","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}
814 in this way it was easier to upkeep the internal medicine units. It is high time that we protested firmly against the depreciation of the significance of internal dis eases in clinical practice. The reasons for this are many, for example they stem from the fact that only the internal medicine specialists can provide a holistic approach to the patient, while at the same time acting as doctors who solve numerous and very difficult clinical problems, working both in their own units as well as in surgical, neurol ogy, infectious diseases, dermatology units, etc. It is known that the internal medicine special ists function successfully for example in the Unit ed States. It has become apparent that experi enced internists are a “treasure” for the hospi tal because they are able to analyze the majori ty of additional tests, be it endoscopic, imaging, or laboratory examination. Then, taking into ac count a clinical picture of a disease, they are able to synthesize all information based on which they tie all loose ends, thus providing a correct diag nosis. One should not forget that a precise diag nosis based on accurate actions and subsequent recommendation of a proper treatment trans lates into tangible economic results. Such actions in a more and more complex area of medicine re quire the implementation of a detailed differen tial diagnosis of diseases, which does not only re late to the work in the internal medicine units but also to consultations in different units for which internists are essential and which also proves to be the reason for their “exploitation”. If we do not restore due importance of internal medicine and its specialists, then we can antici pate that in the near future we will witness more and more mistakes committed by doctors as re gards diagnosis and therapy. Generally speaking, we could be faced with a certain chaos in the area of diagnosis and treatment. We need to remember that in medicine and in patient treatment 2×2 is not always 4. Frequent ly, during the diagnostic process and also during For more than a decade now, we have been ob serving the continued depreciation of internal diseases and internal medicine specialists de spite a huge need for their services, which can be noted in the current activity of the hospitals and outpatient clinics. It was reflected in the closing of internal medicine clinics and supplementing the names of internal medicine units with addi tional terminology related to the detailed special izations rising from the internal medicine, since FORUM FOR INTERNAL MEDICINE
{"title":"Forum for internal medicine: opinions and controversies.","authors":"A. Hrycek","doi":"10.20452/pamw.3624","DOIUrl":"https://doi.org/10.20452/pamw.3624","url":null,"abstract":"814 in this way it was easier to upkeep the internal medicine units. It is high time that we protested firmly against the depreciation of the significance of internal dis eases in clinical practice. The reasons for this are many, for example they stem from the fact that only the internal medicine specialists can provide a holistic approach to the patient, while at the same time acting as doctors who solve numerous and very difficult clinical problems, working both in their own units as well as in surgical, neurol ogy, infectious diseases, dermatology units, etc. It is known that the internal medicine special ists function successfully for example in the Unit ed States. It has become apparent that experi enced internists are a “treasure” for the hospi tal because they are able to analyze the majori ty of additional tests, be it endoscopic, imaging, or laboratory examination. Then, taking into ac count a clinical picture of a disease, they are able to synthesize all information based on which they tie all loose ends, thus providing a correct diag nosis. One should not forget that a precise diag nosis based on accurate actions and subsequent recommendation of a proper treatment trans lates into tangible economic results. Such actions in a more and more complex area of medicine re quire the implementation of a detailed differen tial diagnosis of diseases, which does not only re late to the work in the internal medicine units but also to consultations in different units for which internists are essential and which also proves to be the reason for their “exploitation”. If we do not restore due importance of internal medicine and its specialists, then we can antici pate that in the near future we will witness more and more mistakes committed by doctors as re gards diagnosis and therapy. Generally speaking, we could be faced with a certain chaos in the area of diagnosis and treatment. We need to remember that in medicine and in patient treatment 2×2 is not always 4. Frequent ly, during the diagnostic process and also during For more than a decade now, we have been ob serving the continued depreciation of internal diseases and internal medicine specialists de spite a huge need for their services, which can be noted in the current activity of the hospitals and outpatient clinics. It was reflected in the closing of internal medicine clinics and supplementing the names of internal medicine units with addi tional terminology related to the detailed special izations rising from the internal medicine, since FORUM FOR INTERNAL MEDICINE","PeriodicalId":20343,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej","volume":"24 1","pages":"814-818"},"PeriodicalIF":0.0,"publicationDate":"2016-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78221428","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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